Non-standard Group Research Articles

Analysis of compliance with lung protective mechanical ventilation strategy in patients with acute respiratory distress syndrome

Objective: To assess the compliance with a lung protective ventilation strategy and to evaluate the relationship with prognosis in patients with acute respiratory distress syndrome (ARDS). Methods: In the prospective multicenter cohort study (CHARDS), patients with ARDS undergoing invasive mechanical ventilation were enrolled to collect essential information, mechanical ventilation data, and prognostic data. Compliance was operationally defined as tidal volume ≤7 ml/kg predicted body weight (PBW) or plateau pressure ≤30 cmH2O or driving pressure≤15 cmH2O. Tidal volume data collected 7 days prior to ventilation after ARDS diagnosis were categorized into four groups: standard group (Group A, 100% compliance), non-standard group (Group B, 50%-99% compliance, Group C,1%-49% compliance,and Group D,totally non-compliant). Plateau pressure and drive pressure measurements were recorded on the first day. Stepwise regression, specifically Logistics regression, was used to identify the factors influencing ICU survival. Results: A total of 449 ARDS patients with invasive mechanical ventilation were included; the proportion of mild, moderate, and severe patients was 71 (15.8%), 198 (44.1%) and 180 (40.1%), respectively. During the first 7 days, a total of 2880 tidal volume measurements were recorded with an average tidal volume of (6.89±1.93) ml/kg PBW. Of these measurements, 53.2% were found to be≤7 ml/kg PBW. The rates of compliance with lung protective mechanical ventilation were 29.8% (134/449), 24.5% (110/449), 23.6% (106/449), and 22% (99/449) in groups A, B, C, and D, respectively. In the standard group, the tidal volume for mild ARDS patients was 18.3%(13/71), while it was 81.7%(58/71)in the non-standard group. Similarly, in patients with moderate ARDS, the tidal volume was 25.8% (51/198) in the standard group, while it was 74.2% (147/198) in the non-standard group. Finally, in patients with severe ARDS, the tidal volume was 38.9% (70/180) in the standard group, while it was 61.1% (110/180) in the non-standard group. Notably, the compliance rate was higher in patients with moderate and severe ARDS in group A compared to patients with mild and moderate ARDS (18.3% vs. 25.8% vs. 38.9%, χ2=13.124, P=0.001). Plateau pressure was recorded in 221 patients, 95.9% (212/221) patients with plateau pressure≤30 cmH2O, and driving pressure was recorded in 207 patients, 77.8% (161/207) patients with a driving pressure ≤15 cmH2O.During the first 7 days, the mortality rate in the intensive care unit (ICU) was lower in the tidal volume standard group compared to the non-standard group (34.6% vs. 51.3%, χ2=10.464, P=0.001). In addition, the in-hospital mortality rate was lower in the standard group compared to the non-standard group (39.8% vs. 57%, χ2=11.016, P=0.001).The results of the subgroup analysis showed that the mortality rates of moderate and severe ARDS patients in the standard group were significantly lower than those in the non-standard group, both in the ICU and in the hospital (all P<0.05). However, there was no statistically significant difference in mortality among mild ARDS patients (all P>0.05). Conclusions: There was high compliance with recommended lung protective mechanical ventilation strategies in ARDS patients, with slightly lower compliance in patients with mild ARDS, and high compliance rates for plateau and drive pressures. The tidal volume full compliance group had a lower mortality than the non-compliance group, and showed a similar trend in the moderate-to-severe ARDS subgroup, but there was no significant correlation between compliance and prognosis in patients with mild ARDS subgroup.

Standardized In-harness Ultrasound Protocol Improves Success Rate of Brace Treatment for Dislocated Hips.

Infant hip dislocations benefit from early detection and treatment for optimal outcomes. Prior studies have identified that there remains wide variability in the success rate of bracing between institutions. Although there are standardized methods to screen infants for hip dysplasia, there are no clear guidelines regarding how to image a child being treated for a hip dislocation with a Pavlik harness. As a result, there is substantial variability in how treatment success or failure is monitored between and within institutions. The goal of our study is to determine whether a standardized in-harness imaging protocol improves outcomes and the likelihood of successful treatment for dislocated hips being treated with the Pavlik harness. All patients with hip dislocations and pretreatment ultrasound (US) were included from July 2018 to July 2022. A new institutional US protocol was implemented in July 2020, during which standardized in-harness imaging was obtained for patients with hip dislocations. Patients treated before the implementation of standardized in-harness imaging were categorized as nonstandardized and after implementation as a standardized group. Outcomes were compared between standardized and nonstandardized groups. P <0.05 determined the statistical significance. One hundred twenty-eight hips met the inclusion criteria (n = 97 patients). The mean age at diagnosis was 41.6 ± 23.4 days and was predominantly female (85.6%). There was no significant difference between the patients' demographics and baseline clinical characteristics between the standardized and nonstandardized groups. Pavlik harness success rate was significantly higher in the standardized group (85% vs 60%, P = 0.0024). Twenty-eight hips in the nonstandardized group remained dislocated and were indicated for surgical treatment, whereas only 8 hips remained dislocated in the standardized group and necessitated closed or open reduction. Standardization of in-harness imaging for patients undergoing treatment for developmental hip dislocations can significantly improve the Pavlik harness success rate. These findings emphasize the importance of obtaining images with the hip in flexion and abduction to prevent inadvertent stress during US evaluation for hips that have not yet stabilized, which may lead to premature cessation of the Pavlik harness. Level III.

Effect of continuous renal replacement therapy on the clinical efficacy and pharmacokinetics of polymyxin B in the treatment of severe pulmonary infection

ObjectiveThis study aimed to evaluate the pharmacokinetics of polymyxin B in patients with ventilator-associated pneumonia caused by multi-drug resistant bacteria, and to analyze the effect of continuous renal replacement therapy (CRRT) on pharmacokinetics of polymyxin B. MethodsThirty-five patients with ventilator-associated pneumonia caused by multi-drug resistant bacteria admitted to our hospital from June 2021 to January 2022 were selected as the subjects. The patients were divided into the standard group (n = 20) and the non-standard group (n = 15) based on the factors affecting the compliance of polymyxin B plasma concentration. The patients received with polymyxin B and the plasma concentration was monitored. According to the monitoring results, they were divided into the standard group and the non-standard group, to analyze the influencing factors of polymyxin B on the blood concentration. Besides, the patients were then divided into the control group (n = 28) and the observation group (n = 7) according to whether the patients received CRRT treatment. Patients in the control group treated with polymyxin B alone, while patients in the observation group received with polymyxin B and CRRT. The general data of patients in the two groups were compared. The levels of plasma concentration of polymyxin B measured before the next administration (Cmin), peak plasma concentration of polymyxin B measured immediately after end of infusion (Cmax) and intermediate plasma concentration measured 6 h after administration (midpoint of the dosing interval) (C1/2t) were detected and compared between the two groups. Correlation between pharmacokinetics and efficacy was analyzed by Spearman correlation. The incidence of complications and the 28-day mortality rate of the two groups were recorded. ResultsThe age, body mass index (BMI) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores in the non-standard group were higher than these in the standard group (p < 0.05). BMI and APACHE II scores were independent risk factors affecting the pharmacokinetics of polymyxin B in patients with severe pulmonary infection (p < 0.05). There were no significant differences in age, BMI, APACHEII score, alanine aminotransferase level, aspartate aminotransferase level, albumin level, gender and diabetes ratio between the control group and the observation group (p > 0.05). The levels of Cmin, Cmax, and C1/2t in the observation group were lower than these in the control group (p < 0.001). The response rate was 50.00% in the control group and 36.36% in the observation group (p > 0.05). The levels of Cmin, Cmax, and C1/2t in the observation group were no significant correlation with the clinical efficacy (p > 0.05), while these in the control group were positive correlation with the clinical efficacy (r = 0.485, p < 0.05). There was no significant difference in the incidence of skin pigmentation, nephrotoxicity and 28-day mortality between the two groups (p > 0.05). ConclusionIn patients with ventilator-associated pneumonia not receiving multidrug-resistant bacteria, the rate of achieving blood drug concentration with the usual recommended dose of polymyxin B was satisfactory. However, the proportion of patients with a 6-h plasma concentration exceeding the maximum plasma concentration was high. BMI and APACHE II scores were important factors affecting the pharmacokinetics of polymyxin B. In patients undergoing CRRT, the plasma concentration of polymyxin B was significantly reduced, suggesting that in patients with severe disease, plasma concentration monitoring played an important role in drug efficacy and patient safety. In patients treated with CRRT, the dose of polymyxin B may need to be increased.

(211) Comparable Continence Rates Following Male Urethral Sling Surgery in “Standard” versus “Nonstandard” Patients

Abstract Introduction Transobturator male urethral slings are a surgical option for the management of stress urinary incontinence (SUI). Historically, patient continence and satisfaction rates are influenced by several variables, including: baseline incontinence severity, prior surgical interventions, and exposure to radiation. Ideal or “standard” patients for sling placement have mild or moderate incontinence and no prior incontinence procedures or radiation exposure. Standard patients have been proposed to have better postoperative continence and satisfaction rates than their “nonstandard” counterparts. Objective In this study we sought to compare the efficacy and complication rates of transobturator male sling placement between standard and nonstandard patients. Methods A retrospective, single-institution review was performed of all patients who underwent either an AdVance™ or an AdVanceXP™ sling insertion between October 2016 and May 2023. Patient demographics, preoperative and postoperative continence rates, and complication rates were collected. Patients were then stratified as “standard’ vs “nonstandard”. Standard patients were defined as having a history of radical prostatectomy (robotic or open) and no prior radiation or prior incontinence procedure. Nonstandard patients had prior history of transurethral resection of the prostate, simple prostatectomy, radical cystectomy, prior sling insertion, or prior radiation. The continence and complication rates were compared between groups. Continence was measured in pads per day (PPD). Improvement in continence was defined as a reduction of at least 50% in PPD at 6 weeks postoperatively. Baseline and postoperative PPD were tabulated with median and 25th-75th percentiles, then compared using Wilcoxon signed-rank test. Other variables were summarized with frequency and percentages, and compared using Fisher’s exact test. Results 62 patients were included in this study, of which 48 and 14 were standard and nonstandard, respectively. Mean age was 66 (52-85) years and body mass index (BMI) was 29 (20.3-39.8) kg/m2. No difference in baseline characteristics were noted between the groups (Table 1). 77% of patients had an improvement in SUI following sling placement: 38/48 (79%) patients in the standard group and 10/14 (71%) patients in the non standard group. The most common complication among both groups was urinary retention requiring catheterization (29%), which resolved spontaneously within two weeks in all patients. In the nonstandard group, one patient developed an abscess, one had a scrotal hematoma, and two patients had urinary tract infections (UTI). One patient with history of radiation developed a urethrocutaneous fistula requiring sling removal. There was no significant difference in overall complication rates between standard and nonstandard patients. Comparable rates of improvement in preoperative to postoperative SUI were noted: 2.5 to 0.8 PPD in the standard group and 3.3 to 1.0 PPD in the nonstandard group (Figure 1). Conclusions In this study, nonstandard and standard patients had similar continence and complication rates following urethral sling placement. Future prospective studies are warranted to assess the safety and long-term outcomes of standard and nonstandard patients. Disclosure No.

Standardized surgical strategy for the treatment of preauricular sinus to reduce recurrence.

Preauricular sinus (PAS) is a common congenital anomaly, and complete excision is recommended to prevent recurrence. However, PAS has a high recurrence rate as a result of incomplete removal due to the high variability of the sinus ramifications, making its treatment challenging. In this study, we standardized the surgical procedure to reduce the complications and recurrence rate and compared the postoperative results between the non-standardized and the standardized groups. This retrospective study included 97 patients (120 ears) who had undergone PAS excision by a single surgeon between October 2014 and September 2022 and underwent at least 6 months of follow-up. After October 2018, all patients were treated using the standardized method, which comprised the use of magnifying glasses, exploration with a lacrimal probe, the use of methylene blue staining, and excision of a piece of surrounding normal tissue and related cartilage in continuity with the specimen. There were 38 patients (45 ears) in the non-standardized group and 59 patients (75 ears) in the standardized group. Recurrence was observed in six of 120 ears, indicating an overall recurrence rate of 5.0%. Recurrence occurred in five ears (11.1%) in the non-standardized group and one ear (1.3%) in the standardized group. The standardized group had a significantly lower recurrence rate (p= 0.027) than the non-standardized group. We defined a standardized sinectomy protocol and used it for the surgical treatment of PAS. With this standardized method, we were able to reduce the rates of complications and recurrence without the use of a long incision.

Non-standard groups of the second type

In [4] it is proved that the multiplicative group Fp⁎ is an automatically non-standard f-subgroup, here called a non-standard f-subgroup of the second type, for suitable f(x)∈Fp[x] whenever p is a prime with p>3 and p≡3(mod4). Here we extend this result to all odd non-Fermat primes p, and give two different proofs. Our first proof is an elaboration of that in [4], while the second proof leads to a general lower bound on the number of f-sequences that represent a non-standard f-subgroup of the second type; in certain very special cases, this lower bound is shown to be exact, although it is known not to be exact in general.

Pro et contra of frontier interpretation of Sintashta antiquities (Bronze Age in the Southern Urals)

The practice of archaeological research often illustrates situations where the sum of facts does not corre-spond to the cultural-historical approach; it is impossible to squeeze this sum into the framework of the term “ar-chaeological culture”. Deviations from his canonical understanding of the term may relate to the duration of the phenomenon, its spatial distribution or the degree of stereotyping of material culture and rituals. The frontier can be one of the options for interpreting such non-standard groups of archaeological objects. The purpose of the study is to test the possibilities of using the concept for the interpretation of the Sintashta sites of the Bronze Age of the Southern Urals (the turn of 3rd — 2nd millennium cal BC) in the light of new data from a comprehensive study (paleogenetics, chronology, etc.). Sintashta settlements and cemeteries are located on the compact territory of the northern steppe: settlements in the Trans-Urals, the burial ground — on both sides of the Ural Mountains. Previous studies have accumulated a huge amount of data on all major aspects, but the general concept remains debatable. The new data comes from mass radiocarbon dating, which allowed to use Bayesian modeling. New data of mass radiocarbon dating confirm the brevity of the functioning of the Sintashta settlements and burial grounds, as well as the possibility of partial synchronization of this tradition with others. Paleogenetic analyzes (more than 50 samples) have shown the heterogeneity of the Sintashta population. Peleogenetic data made it possible to diagnose traces of a subtratian population absorbed by the main migratory group. In material culture, The evidences in material culture are not traced. The same data confirmed a special scenario for the formation of necropolises, weakly associated with the consanguinity of the buried individuals. Only 1/5 of the deceased turned out to be relatives of the first and second degree. The new data significantly complement the previously formulated crite-ria, which allow us to consider the group of Sintashta sites as a reflection of the situation of the frontier. The Sin-tashta society in the frontier was formed as complex society. But it did not have the prospect of forming statehood.

Patient Education with New Media Integration Self-Management Support Model Improves Therapeutic Outcomes of Rosacea Patients.

To retrospectively analyze the factors influencing the treatment of rosacea patients with regular follow-up by self-management support in the new media chronic disease management model, to explore the effect of self-management support and to provide an objective basis for clinical application. Female patients with rosacea who were regularly followed up for more than 6 months at the rosacea follow-up clinic of the Department of Dermatology, West China Hospital, Sichuan University, from March 2022 to June 2023, with erythema and capillary dilation as the main clinical phenotype, met the rosacea diagnostic criteria of the American Rosacea Expert Committee 2017 edition, and received medications recommended by the Chinese Rosacea Treatment Guidelines (2021 edition). A total of 125 patients were treated with combined photobiomodulation therapy (PBMT), and the patients were divided into a standardized group (CEA<1, IGA<1) and a non-standardized group (CEA≥1, IGA≥1) based on significant rosacea efficacy (CEA<1, IGA<1) within 6 months. The age, gender, education level, duration of rosacea, treatment regimen, education intensity, CEA, and IGA baseline data were compared between the two groups, and logistic regression analysis was performed to analyze the factors influencing the significant efficacy of rosacea. There was a significant difference in the mean length of education between the two groups (P<0.05), and the differences between the rest of the baseline information of the two groups were not statistically significant (P>0.05). Logistic regression analysis showed that the variable that significantly influenced the efficacy of treatment was the mean length of education (≥130.5 min/month), and the intensity of education was significantly associated with the efficacy of treatment. Self-management support in the new media chronic disease management model has a positive impact on the treatment of rosacea patients.

The Analysis of Preoperative Roussouly Classification on Pain Scores and Radiological Data in Lateral Lumbar Interbody Fusion for Patients with Lumbar Degenerative Disease

A retrospective observational study. The type of sagittal profile defined by Roussouly has affected spinal degeneration and surgical outcome. This study aimed to investigate the effect of preoperative Roussouly classification on pain intensity and radiological data of patients with lumbar degenerative disease who underwent indirect decompression with lateral lumbar interbody fusion (LLIF). We retrospectively investigated 102 patients who underwent LLIF without direct decompression. Patients were subdivided into 4 groups according to the Roussouly classification determined from preoperative full-length and lateral spine X-rays, and classified according to Roussouly types I, II, and IV in the nonstandard group and Roussouly type III in the standard group. The nonstandard group showed improved sagittal vertical axis and lumbar lordosis after LLIF surgery, but the midsagittal canal diameter and axial central canal area of the thecal sac using T2-weighted sagittal and axial magnetic resonance imaging were smaller than those in the standard group. On the other hand, each numeric rating scale score 1year after surgery improved in all patients. Changes in numeric rating scale scores in low back pain, leg pain, and numbness were not statistically significant between Roussouly classification types. These results suggest that the nonstandard group may have less indirect decompression effect from LLIF than the standard group. In the short term, we show for the first time after LLIF surgery that preoperative sagittal spinal alignment and the pelvic position may not significantly impact pain improvement.

Multifactorial analysis of renal anemia-associated substandard hemoglobin levels and prevalence of anemia in patients on maintenance hemodialysis in Liaoning Province: a cross-sectional study

In hemodialysis (HD) patients, anemia is greatly improved due to regular weekly use of iron and erythropoietin (EPO), but a large number of patients still show persistent anemia. We do a survey to elucidate the influencing factors that contribute to the failure of hemoglobin (Hb) to meet the standard and provide epidemiological data reference for promoting the recognition of renal anemia and improving the treatment effect of renal anemia. The clinical data of End-Stage Renal Disease (ESRD) HD patients in 22 tertiary hospital HD centers in Liaoning Province from September 2021 to June 2022 were collected by convenient sampling. According to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) anemia diagnostic criteria. The standard of Hb compliance: Hb ≥110 g/L is considered as Hb compliant, and Hb <110 g/L as Hb non-compliant. The factors influencing Hb up-to-standard in ESRD HD patients and their correlations were analyzed by comparison between the two groups. The results of this study showed that among the 1,652 ESRD patients investigated in Liaoning Province, the prevalence rate of anemia was 89.29% (1,475/1,652), and the Hb compliance rate was 46.25% (764/1,652). The Hb compliance rate in maintenance hemodialysis (MHD) patients with different primary diseases was statistically significant (P<0.05). Compared with the Hb non-standard group, the gender, dialysis access, HD frequency, concurrent infection, primary disease of ESRD patients, red blood cell (RBC) count, hematocrit (HCT), mean RBC Hb concentration, mean RBC Hb content, platelet (PLT), albumin (ALB), total protein (TP), serum creatinine (Cr), serum calcium (Ca), serum potassium (K), ferritin (Fer), serum iron (SI), and transferrin (TRE) saturation were significantly different between both groups (P<0.05). Adrenaline was an independent risk factor affecting Hb failure in ESRD patients (OR =1.001, 95% CI: 1.000-1.002); dialysis frequency (OR =0.726, 95% CI: 0.601-0.878), ALB (OR =0.959, 95% CI: 0.929-0.990), TP (OR =0.982, 95% CI: 0.968-0.996), serum Cr (OR =0.959, 95% CI: 0.929-0.999), and SI (OR =0.961, 95% CI: 0.940-0.982) were protective factors affecting Hb failure in ESRD patients (P<0.05). Pearson correlation analysis showed that ALB, TP, serum Cr, serum Ca, serum K, SI, and TRE saturation were positively correlated with Hb (P<0.05). The anemia rate of ESRD patients treated with MHD in Liaoning Province is high. Based on the results, increasing the frequency of dialysis can improve anemia. Parathyroid hormone levels need to be controlled.

Comparison of Short-Term Outcomes for Standard Versus Nonstandard Induction Dosing of Infliximab for Pediatric Inflammatory Bowel Disease.

Recent studies have emphasized the early use of infliximab (IFX) in pediatric patients with inflammatory bowel disease. Standard dosing of 5 mg/kg/dose may not be sufficient to achieve optimal clinical outcomes. The aim of our study was to compare short-term outcomes with standard dosing of IFX to higher, nonstandard dosing of IFX for induction therapy. Retrospective study of 162 pediatric patients receiving either standard (5-6 mg/kg, n = 90) or nonstandard (>6 mg/kg, n = 72) dosing of IFX during induction was performed. Patient demographics, clinical outcomes, and laboratory data were collected. Need for dose escalation during the first 6 months, combination therapy with immunomodulators, and steroid-free progression were investigated. Clinical remission rates between the 2 groups were significantly different, with patients receiving nonstandard dosing demonstrating higher rates (58% vs 78%; p = 0.012). Use of combination therapy with immunomodulators was significantly different between standard and nonstandard groups (80% vs 48%; p < 0.001). Numeric trend in need for IFX dose escalation in the first 6 months was seen between standard and nonstandard groups (54% vs 39%, respectively; p = 0.087). Post-induction IFX trough concentrations, rates of antibody development, drug discontinuation, and infusion reaction were similar. Nonstandard induction dosing of IFX was associated with higher rates of clinical remission, despite similar rates of serum IFX trough concentrations. There was a numeric trend towards the standard group requiring dose escalation within the first 6 months of therapy. Patients given nonstandard dosing may achieve superior clinical outcomes compared with those on standard dosing.

Keeping up with this workload is difficult: the ramifications of work overload on career resilience

PurposeA paradigm shift toward a corporate model of higher educational settings has led to complex and excess work demands, yet the potential long-run ramifications of work overload are still under-examined. Building the arguments on the “spiral of resource loss” corollary of the conservation of resources (COR) theory, the authors have bridged this gap by testing how work overload spills over into career resilience via reduced harmonious passion. In addition, the authors compare how the employees having standardized workloads differ in their harmonious passion and career resilience from those having excessive (non-standardized) workloads.Design/methodology/approachThrough a longitudinal natural field experiment of 402 faculty members [N = 198 in the standardized group (optimal load) and N = 204 in the non-standardized group (overload)] working in higher educational institutions of Pakistan, data were collected in three waves (each six months apart). The group comparison, trend analysis and longitudinal mediation analysis done through SPSS and MPlus affirmed the hypothesized associations.FindingsThe results have shown that work overload impacts career resilience through the mediating role of harmonious passion. The faculty members in the standardized workload had more passion and career resilience as compared to the non-standardized workload group. In addition, these impacts intensified overtime for the overloaded faculty members while faculty members with optimal workload sustained their passion and resilience for the teaching profession.Originality/valueTaking the COR perspective, this study sheds light on how faculty members' work overloads reduce their capability to retain their passion and resilience for teaching from a longitudinal and experimental perspective.

Usefulness of the G8 Screening Tool in Determining Treatment Strategies for Definitive Radiotherapy of Esophageal Cancer in the Elderly

<h3>Purpose/Objective(s)</h3> Recent clinical trials for chemoradiotherapy (CRT) in esophageal cancer, such as ARTDECO and CONCORDE used elective nodal irradiation (ENI). However, it is often difficult to perform standard CRT for the elderly in the real world, and also there is no clear consensus on the criteria for this decision. Recently the G8 screening tool for geriatric assessment has been attracting attention in the oncology field. This study aimed to investigate the relationship between the treatment strategy of definitive RT and the G8 score for esophageal cancer in the elderly. <h3>Materials/Methods</h3> We analyzed 81 esophageal cancer patients aged ≥65 years (27 aged ≤74 years, 26 aged 75-79 years, and 28 aged ≥80 years) who received definitive RT between 2018 and 2021. The G8 screening tool was performed at the first visit to the radiation oncology department. The treatment strategy was decided by a conference between the radiation oncologist and esophageal surgeon, and the G8 score was not used to determine the treatment strategy. Standard RT was defined as ENI and a total dose ≥50 Gy, and standard chemotherapy (ChT) was defined as two cycles of platinum (70 mg/m2) and 5FU (700 mg/m2 for 4 days) concurrently. Patients who underwent standard RT and standard ChT were defined as the standard group and the rest as the non-standard group. The Mann-Whitney U test was used to compare the two groups, and statistical significance was set at p<0.05. The Receiver Operating Characteristic (ROC) curve was used to calculate the cutoff value. <h3>Results</h3> The mean G8 scores by age were 12.7 (range: 7-17) for ≤74 years, 12.9 (range: 7-17) for 75-79 years, and 10.4 (range: 4.5-15) for ≥80 years, and significantly lower scores for ≥80 years, but no significant difference between ≤74 and 75-79 years. There were 26 patients in the standard group, of which only one was ≥80 years. In the patients ≤79 years, the G8 score was significantly higher in the standard group (mean: 13.9 points in the standard group and 11.6 points in the non-standard group) (p<0.01), but age was not significantly different between the standard and non-standard groups (p=0.94). The cut-off value of the G8 score calculated by the ROC curve was 13 points. In patients ≥80 years, 10 patients received CRT (1 standard ChT, 9 reduced ChT), and 15 of 18 patients in the RT alone group received only local RT. In the patients ≥80 years, the G8 score was significantly higher in the CRT group (mean: 12.5 points in the CRT group and 9.2 points in the RT group) (p<0.01), but age was not significantly different between the CRT and RT groups (p=0.08). The cut-off value of the G8 score calculated by the ROC curve was 12 points. <h3>Conclusion</h3> Our results suggest that the G8 screening tool may be useful in determining the treatment strategy of definitive RT for esophageal cancer in the elderly. Future investigation of the relationship between the G8 score and treatment outcomes is required.

No more career resilient and passionate! A longitudinal experimental insight into work overload

Complex and excess work demands are a byproduct of corporate model in higher educational settings, however, how work overload manifests in long-run career outcomes is yet to be examined. We therefore built on the ‘primacy of resource loss’ corollary of the Conservation of Resources theory to find out the repercussions of work overload on career resilience via reduced harmonious passion. We conducted a longitudinal natural field experiment of 402 faculty members (N=198 in the standardized group (optimal load) and N= 204 in the non-standardized (overload) group working in Higher Educational Institutions in Pakistan. Data were collected in three waves (six months apart). The analysis was performed through group comparisons, trend analysis, and longitudinal mediation analysis, using SPSS and MPlus. Our findings suggest that, as opposed to the much-held conception of harmonious passion and career resilience as buffering resources to sustain work overload, these rescores are also depleted by the same phenomenon. Based on these results, we suggest that faculty members should be given optimal workload to retain their passion and resilience for teaching.

Clinicopathological analysis of 285 cases of elderly patients with epithelial ovarian cancer.

e17539 Background: Elderly patients with epithelial ovarian cancer often cannot receive standard treatment, and their survival time decreases with age, seriously threatening their lives. Elderly patients with epithelial ovarian cancer tend to have many complications and poor tolerance to surgery and chemotherapy, resulting in poor overall prognosis. Methods: The clinicopathological data of EOC patients aged ≥ 60 years old who were diagnosed and treated in our hospital from January 2013 to January 2018, with completed clinical and pathological data were collected for analysis and followed up through outpatient review, telephone, WeChat, QQ group, etc. to analyze the diagnosis and treatment plan and main prognostic factors. The deadline for follow-up was March 1, 2020. Results: Comparison of recurrence and the overall survival in different groups, the results respectively showed that the difference had statistically significant (χ2 = 255.027, p &lt; 0.001) 、(χ2 = 314.443, p &lt; 0.001). Analysis of the factors affecting the recurrence and death of patients showed that the results of single factor analysis showed age, BMI, Combined with cardiovascular and cerebrovascular diseases, pre-treatment CA125 value, thrombus score, FIGO staging, pathological type, residual lesion size are the influencing factors of recurrence. Further multivariate analysis showed that combined cardiovascular and cerebrovascular diseases, pre-treatment CA125 value, FIGO stage, residual lesion size is an independent factor affecting relapse. The median survival time of relapse-free in the neoadjuvant chemotherapy group was 39.00 (30.67̃44.95) months; the median survival time of relapse-free in the directing surgery group was 36.00 (29.47̃42.53) months, statistical comparison showed no significant difference (χ2 = 2.426, p = 0.119). The total median survival time of the neoadjuvant chemotherapy group was 49.57 months; for the directing surgery group, the total median survival time was 47.07 months, and the statistical comparison showed no significant difference (χ2 = 0.166, p = 0.684). Conclusions: For the epithelial ovarian cancer in elderly patients the results showed that the standard treatment group was better than the non-standard treatment group, chemotherapy-only group, surgery-only group, and untreated group. Comparing with primary tumor debulking surgery (PDS),neoadjuvant chemotherapy-Interval debulking surgery (NACT-IDS) group could improve the intraoperative situation，reduce the amount of intraoperative bleeding, shorten the operation time, reduce the wound healing rate and the incidence of surgical complications, but it had no effect on the tumor removal rate, PFS and OS.

Eculizumab treatment and discontinuation in pediatric patients with atypical hemolytic uremic syndrome: a multicentric retrospective study.

Eculizumab is effective treatment of pediatric atypical hemolytic uremic syndrome (aHUS). However, the optimal duration of treatment is not clearlydefined. The aim of this study was to retrospectively analyze the outcome of pediatric patients with aHUS, who started eculizumab treatment but discontinued it during the follow-up period. The clinical and laboratory findings of the pediatric patients with aHUS were recorded on a web-based, national registry system, known as the Turkish aHUS Registry. The study included 63 patients who had to have received more than four doses of eculizumab duringthe acute phase of the disease. The median age at diagnosis was 3.62 (IQR: 1.29-6.14) years. During the follow-up period, 39 patients continued to receive standard eculizumab treatment (standard treatment group, treatment every 2 weeks) while 24 received an extended dose of eculizumab at three-four-week intervals (non-standard treatment group). There was no significant difference between both groups in terms of clinical and laboratory parameters. Eculizumab treatment was discontinued in 18 patients (30.7%, F/M:11/7), and the median age of these patients at diagnosis and their median follow-up duration were 4.0 (IQR:2.7-10.2) and 4.2 (IQR:2.2-7) years respectively. The median eGFR at the last visit was 110 (84.7-146.1)ml/min/1.73 m2. Fourteen patients remained in remission without any sign of the disease. Recurrence occurred in four (22.2%) patients, inwhich eculizumab was immediately started again and completeremission was achieved. Eculizumab is a successful treatment option in pediatric patients with aHUS and it can be safely discontinued with close monitoring in a selected group of patients. In case of recurrence, eculizumab should be restarted immediately to achieve complete remission.

The choice of a neoadjuvant chemotherapy cycle for breast cancer has significance in clinical practice: results from a population-based, real world study.

Objective:Neoadjuvant chemotherapy (NAC) is currently used in both early stage and locally advanced breast cancers. The survival benefits of standard vs. non-standard NAC cycles are still unclear. This study aimed to investigate the relationship between NAC cycles and survival based on real world data.Methods:We identified patients diagnosed with invasive primary breast cancers who underwent NAC followed by surgery. Patients who received at least 4 NAC cycles were defined as having received standard cycles, while patients who received less than 4 NAC cycles were defined as having received non-standard cycles. Kaplan-Meier curves and Cox proportional hazard models were used to estimate the disease-free survival (DFS) and overall survival (OS).Results:Of the 1,024 included patients, 700 patients received standard NAC cycles and 324 patients received non-standard NAC cycles. The DFS estimates were 87.1% and 81.0% (P = 0.007) and the OS estimates were 90.0% and 82.6% (P = 0.001) in the standard and non-standard groups, respectively. Using multivariate analyses, patients treated with standard NAC cycles showed significant survival benefits in both DFS [hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.44–0.88] and OS (HR: 0.54, 95% CI: 0.37–0.79). Using stratified analyses, standard NAC cycles were associated with improved DFS (HR: 0.59, 95% CI: 0.36–0.96) and OS (HR: 0.49, 95% CI: 0.28–0.86) in the HER2 positive group. Similar DFS (HR: 0.50, 95% CI: 0.25–0.98) and OS (HR: 0.45, 95% CI: 0.22–0.91) benefits were shown for the triple negative group.Conclusions:Standard NAC cycles were associated with a significant survival benefit, especially in patients with HER2 positive or triple negative breast cancer.

P135. Does a dedicated scoliosis team and surgical standardization improve outcomes in adolescent idiopathic scoliosis surgery and is it reproducible?

<h3>BACKGROUND CONTEXT</h3> Expedited recovery after surgery protocols and the perioperative surgical home are two initiatives that address the need for increased efficiency in patient care. In 2011, we implemented a standardized approach including a "scoliosis team" of dedicated anesthesiologists, operating room nurses, surgical technicians, and neurophysiologists. We also implemented a standardized preoperative work-up, specific intraoperative protocols including the use of anti-fibrinolytics and intrathecal morphine, and a multidisciplinary postoperative care model. <h3>PURPOSE</h3> The purpose of this study is to determine if standardization improves AIS surgery outcomes and whether it is transferrable between institutions. <h3>STUDY DESIGN/SETTING</h3> Retrospective multicenter review. <h3>PATIENT SAMPLE</h3> Adolescent Idiopathic Scoliosis patients that underwent surgery between 2009 and 2018. <h3>OUTCOME MEASURES</h3> Surgical outcomes including operative time and length of stay. <h3>METHODS</h3> In each institution, a non-standardized group (NST) and a standardized group (ST), were compared. Demographics and perioperative outcomes were recorded. In 2015, the surgeons changed institutions (to IB). Reproducibility was determined between institutions (IA vs IB). Median (IQR), Kruskal-Wallis, and Fisher's exact test were used. <h3>RESULTS</h3> A total of 325 AIS patients were collected from the database. The non-standardized group (NST) included 44 patients, while the standardized group (ST) included 281 patients. Age (p=0.21), BMI (p=0.48), preoperative Cobb angle (p=0.48), levels fused (p=0.42), and correction percentage (p=0.39) were all similar. Standardized protocol patients had lower estimated blood loss (EBL) (700 ml vs 325 ml, p<0.001), shorter anesthesia time (437 min vs 384 min, p=0.004), shorter surgical time (310 min vs 248 min, p<0.001), and shorter length of stay (LOS) (7 days vs 5 days, p<0.001). IA (n=101) and IB (n=105) were compared. Age (p=0.21), BMI (p=0.48) and preoperative Cobb angle (p=0.48) were similar. EBL (p<0.001), anesthesia time (p<0.001), surgical time (p<0.001), and LOS (p<0.001) were significantly lower in IB. <h3>CONCLUSIONS</h3> A standardized AIS approach including a dedicated operative team, preoperative work up, postoperative multidisciplinary management, and streamlined surgical steps improves outcomes and efficiency. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Orbifolds from modular orbits

Given a two-dimensional conformal field theory with a global symmetry, we propose a method to implement an orbifold construction by taking orbits of the modular group. For the case of cyclic symmetries we find that this approach always seems to be consistent, even in asymmetric orbifold cases where the usual construction does not yield a modular invariant theory; our approach keeps modular invariance manifest but may give a result that is equivalent to the original theory. For the case that the symmetry is a subgroup of a continuous flavor symmetry, we can give explicit constructions of the spectrum, with twisted sectors corresponding to a non-standard group projection on an enlarged twisted sector Hilbert space.

Analysis of Lumbar Sagittal Curvature in Spinal Decompression and Fusion for Lumbar Spinal Stenosis Patients under Roussouly Classification.

To evaluate the clinical significance of spinal decompression and fusion for lumbar spinal stenosis in old patients under Roussouly classification, 160 old patients (>60 year old) with lumbar spinal stenosis underwent spinal decompression, and fusion were retrospectively studied. According to Roussouly classification, patients were divided into 4 groups, in which Roussouly types I, II, and IV were the nonstandard group and Roussouly type III was the standard group. Visual analog scale (waist, leg) and Oswestry disability index (ODI) scores were recorded before operation and at the final follow-up. All patients improved the sagittal curvature: for patients in Roussouly types I and II, there were statistically significant differences in terms of postoperative global lordosis (GL), global kyphosis (GK), sacral slope (SS), sagittal vertical axis (SVA), and pelvic tilt (PT) compared with that before surgery (all P < 0.001); patients in Roussouly type IV obtained similar results with type III after surgery. The four groups showed significant improvement in ODI and VAS scores at final follow-up (all P < 0.001). After regrouping at the final follow-up, the proportion of the standard type (Roussouly type III) patients was increased compared with preoperative. In conclusion, Roussouly classification has important guiding significance in spinal decompression and fusion for old patients (>60 years) with lumbar spinal stenosis.