Outcome In Young Adult Patients Research Articles

Dynamic LVEF Decline and Serum NT-proBNP and Uric Acid Levels before Heart Transplantation are Independent Predictors of Adverse Outcomes in Young Adult Patients with Dilated Cardiomyopathy.

The present study investigated the predictors of adverse outcomes in young adult patients with dilated cardiomyopathy (DCM) who underwent heart transplantation (HTx). Twenty-four young adult patients (aged 18-45 years) with DCM who underwent HTx in our hospital from January 2012 to December 2022 were included in this retrospective analysis. Pre- and post-HTx data were collected for echocardiography, N-terminal pro-brain natriuretic peptide (NT-proBNP), and uric acid (UA). Data collected at the time of DCM diagnosis were designated as baseline data. Post-HTx assessments were conducted at 1 week and 3, 6, 12, and 36 months post-HTx. The primary endpoint was defined as any adverse event, including left ventricular ejection fraction (LVEF) 50% (n = 3), 50% increase in right or left ventricular diameter (n = 12), or death (n = 2). Patients were categorized into a non-adverse-event group (n = 12) or an adverse-event group (n = 12). Baseline NT-proBNP (p = 0.014) and UA (p = 0.012) were significantly higher in the adverse-event group than in the non-adverse-event group. Baseline NT-proBNP 7390 pg/mL (relative risk (RR) = 7.412, p = 0.046), UA 542 µmol/L (RR = 8.838, 95% confidence interval (95% CI) = 1.541-50.694, p = 0.014), and sustained reduction in LVEF ( 3%) over a 2-year pharmacological treatment prior to HTx (RR = 3.252, p = 0.046) were significantly associated with an increased risk of adverse events post-HTx. In young adult DCM patients post-HTx, heightened baseline levels of NT-proBNP and UA levels and a sustained reduction in LVEF over time prior to undergoing an HTx are significantly associated with an increased risk of adverse events post-HTx. Future studies are needed to observe whether individualized monitoring strategies could reduce the incidence of adverse events following HTx in these patients.

The outcome of closure of inguinal hernia with laparoscopic percutaneous extraperitoneal closure in young adults.

Hernioplasty is one of the most commonly performed surgeries. However, the optimal procedure for young adults has not been defined yet. Our study compared the outcomes of laparoscopic percutaneous extraperitoneal closure (LPEC) in young adults with outcomes in children. We retrospectively reviewed patients aged 0-30years who underwent LPEC. Data regarding age, sex, hernia type, surgical time, pre-intraoperative laterality, contralateral patent processus vaginalis (CPPV), and complications were analyzed. LPEC was performed on 2642 patients in our hospital. Of these, 51 patients were young adults (aged 15-30years). Asymptomatic CPPV in unilateral patients was frequent in the <15-year age group (50.2%) compared to the 15-30-year age group (15.9%). The median surgical time was shorter in the <15-year age group (19min, interquartile range [IQR]: 24-33) compared to that of the 15-30-year age group (33min, IQR: 23.3-40.8). This is the first report on the outcomes in young adult patients who underwent LPEC. The median surgical time was longer in the 15-30-year age group than in the <15-year age group. The median follow-up was 4.7years with no intra-postoperative complications, such as postoperative bleeding, infection, persistent pain, and recurrence. LPEC is an effective, cosmetic, and safe surgical treatment in young adults and children.

1579P Gender differences and worse metastatic survival outcomes in young adult patients with oesophagogastric cancer: 12-year data from a Czech comprehensive cancer center

1579P Gender differences and worse metastatic survival outcomes in young adult patients with oesophagogastric cancer: 12-year data from a Czech comprehensive cancer center

Early and long-term outcomes of young adult patients ≤30 years old with acute type A aortic dissection.

The aim of this study was to investigate the early and long-term outcomes after total arch replacement (TAR) and frozen elephant trunk (FET) implantation in adult patients ≤30 years with acute type A aortic dissection (ATAAD). All young adult patients (≤30 years) with ATAAD who underwent TAR and FET between 2009 and 2017 were enrolled. The end points were major organ morbidity and mortality, aortic-related events and reoperation. The mean age of all 83 patients was 25.9 (standard deviation, 3.3) years. The in-hospital mortality was 9.64% (8/83), and 9 (10.8%) patients required re-exploration for bleeding. The aortic-related events risk was 42.7% (32/75) and the aortic reoperation risk was 17.3% (13/75). Overall survival was 85.5% [95% confidence interval (CI), 75.9-91.5%] at 5 years and 75.9% (95% CI, 63.3-84.7%) at 10 years. The cumulative incidence of aortic-related events was 35% (95% CI, 24-47%) at 5 years and 58% (95% CI, 36-75%) at 10 years; the cumulative reoperation rate was 15% (95% CI, 7.9-24%) at 5 years and 17% (95% CI, 9.2-27%) at 10 years. Marfan syndrome significantly increased the aortic-related events (P = 0.036) and reoperation (P = 0.041) risks. Despite extensive repair in young ATAAD patients, the late aortic dilatation and reoperation risk remain high. The TAR and FET procedures achieved satisfactory early outcomes and reduced late aortic dilatation and reoperation in young patients compared with other records. Close follow-up and aggressive early reintervention are essential for patients with aortic-related risk factors early in life.

Venous thromboembolism characteristics, treatment and outcomes in young adults: findings from the Registro Informatizado de Enfermedad TromboEmbólica registry

BackgroundVenous thromboembolism (VTE) is rare in patients aged <21 years. Young adults aged 18 to 21 years are frequently included in adult VTE studies, whereas pediatric VTE studies include patients aged up to either 18 or 21 years. The clinical characteristics of young adult patients with VTE have not been well defined. ObjectivesWe aimed to highlight any unique characteristics or treatment considerations that may apply to young adult patients with VTE. MethodsData from the prospective, international Registro Informatizado de Enfermedad TromboEmbólica registry were used. Patients were stratified into subcohorts according to age. The clinical characteristics, risk factors, management, and outcomes of young adult patients with VTE were compared with those of adolescents aged 12 to 18 years and adults aged >21 years. ResultsOf 104 253 Registro Informatizado de Enfermedad TromboEmbólica patients enrolled until August 2022, 234 were adolescents and 884 were young adults. Less cases of pulmonary embolism were reported in adolescents (P < .001). Estrogen use was a common risk factor, more prevalent in adolescents and young adults (P < .001), whereas active cancer and immobilization were uncommon in both. Most patients were initially treated with low-molecular–weight heparin. VTE recurrence, major bleeding, and all-cause mortality rates were comparably low among adolescents and young adults. None of the patients aged <21 years died from VTE recurrence. ConclusionYoung adults have some distinctive VTE risk factors. While VTE presentation may be similar among young adults and older patients, the outcomes of patients aged <21 years are more favorable.

Clinical Characteristics and Outcomes of Young Adult Patients with Small Intestinal Neuroendocrine Tumors Differ from Those of Older Adults

INTRODUCTION: Small intestinal neuroendocrine tumors (siNETs) are most commonly diagnosed in the sixth and seventh decades of life. Little is known about the characteristics and outcomes of patients diagnosed at younger ages. METHODS: The National Cancer Database was queried for patients diagnosed with siNETs from 2004 to 2018. Young adults (18 to 39 years) and older adults (40+ years) were compared using Wilcoxon and Chi-square tests and Kaplan-Meier estimates. RESULTS: A total of 26,902 adults with siNETs were identified. Median age was 62 years (interquartile range [IQR] 53 to 71). Young adults (1,130; 4.2%) were more likely to be of non-white race (21.2% vs 15.0%, p < 0.001) and Hispanic ethnicity (8.4% vs 4.5%, p < 0.001). Of young adults, 51.9% had stage 3 disease and 24.7% had stage 4 disease, compared with 54.4% and 29.2%, respectively, of older adults (p < 0.001); 91.5% of young adults and 91.6% of older adults underwent resection (p = 0.89). Young adults were more likely to have negative margins (90.6% vs 84.7%, p < 0.001) and more regional nodes examined (median 11.0 (IQR 1.0 to 20.0) vs 9.0 (IQR 1.0 to 16.0), p < 0.001). Ninety-day mortality was 0.9% for young adults and 3.5% for older adults (p < 0.001). Across all stages, young adults had more favorable 5-year survival (Table). Table. - Clinical Characteristics and Survival Rates of Young vs Older Adults with siNETs Variable Young adults (n = 1,130) Older adults (n = 25,772) p Value Grade 1 76.9% 79.9% 0.046 Grade 2 20.7% 18.1% Grade 3 2.4% 2.0% Stage 1-2 23.4% 16.4% <0.001 Stage 3 51.9% 54.4% Stage 4 24.7% 29.2% 5-year survival: stage 1–2 93.2% (95% CI 88.0–98.5) 80.3% (95% CI 78.6–82.0) <0.001 5-year survival: stage 3 97.0% (95% CI 94.7–99.1) 86.6% (95% CI 85.8–87.5) 5-year survival: stage 4 84.1% (95% CI 78.3–90.3) 71.3% (95% CI 69.8–72.9) CONCLUSION: Young adults with siNETs are demographically different from older patients, with a higher percentage of non-white and Hispanic patients. Young adults present with less advanced disease and are more likely to undergo resection with negative margins and have more regional nodes examined. Young adults have more favorable short- and long-term survival regardless of stage, which warrants separate evaluation for prognostication.

122 Outcomes in Young Adult Patients with Intracapsular Femoral Neck Fractures

Abstract Aim The aim was to evaluate short- and long-term outcomes for young adult patients undergoing fixation for an intracapsular femoral neck fracture. Method From 2008–2018, we retrospectively identified 112 consecutive patients (mean age 48yrs [20–60], 54% male). Complication details were determined from medical records and radiographs. Long-term patient-reported outcomes – including Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimension (EQ-5D)/Visual Analogue Scale (EQ-VAS) and UCLA Activity Scale – were obtained via telephone survey. Results Union occurred in 77% (n=86/112) at a mean of nine months (3–87). Complications occurred in 23% (n=26/112), including fixation failure (5.4%, n=6/112), nonunion (4.5%, n=5/112) and AVN (14.3%, n=16/112). Alcohol excess (p=0.04), time to surgery &amp;gt;24hrs (p=0.023) and fracture malreduction (p=0.002) were associated with complications. Overall, 35% required further surgery, including metalwork removal (18.8%, n=21/112), total hip replacement (18.8%, n=21/112) and excision arthroplasty (1.8%, 2/112). Long-term outcomes were obtained for 72% (n=81/112) at a mean of 6.9yrs (2.8–12.8). The mean OHS was 41.4 (4–48), FJS 63.3 (0–100), EQ-5D 0.823 (-0.59–1.0) and EQ-VAS 79.5 (5–100). Mean EQ-5D was significantly lower than population controls (p=0.005). The mean UCLA score fell from 6.8 pre-injury to 6.0 post-injury (p&amp;lt;0.001). Patients with complications had significantly lower OHS (p&amp;lt;0.001), EQ-5D (p=0.001), EQ-VAS (p=0.01) and UCLA scores (p=0.001) compared with those who united uneventfully. Conclusions Most young adult patients united following fixation of their fracture. However, one in four experienced a complication, resulting in inferior long-term function and health-related quality of life. Time to surgery and fracture reduction were significantly associated with complications.

Characteristics and Outcomes of Young Adult Patients with Severe Sepsis Admitted to Pediatric Intensive Care Units Versus Medical/Surgical Intensive Care Units.

Purpose: Young adults receive severe sepsis treatment across pediatric and adult care settings. However, little is known about young adult sepsis outcome differences in pediatric versus adult hospital settings. Material and Methods: Using Truven MarketScan database from 2010-2015, we compared in-hospital mortality and hospital length of stay in young adults ages 18-26 treated for severe sepsis in Pediatric Intensive Care Units (PICUs) versus Medical ICUs (MICUs)/Surgical ICUs (SICUs) using logistic regression models and accelerated time failure models, respectively. Comorbidities were identified using Complex Chronic Conditions (CCC) and Charlson Comorbidity Index (CCI). Results: Of the 18 900 young adults hospitalized with severe sepsis, 163 (0.9%) were treated in the PICU and 952 (5.0%) in the MICU/SICU. PICU patients were more likely to have a comorbid condition compared to MICU/SICU patients. Compared to PICU patients, MICU/SICU patients had a lower odds of in-hospital mortality after adjusting for age, sex, Medicaid status, and comorbidities (adjusting for CCC, odds ratio [OR]: 0.50, 95% CI 0.29-0.89; adjusting for CCI, OR: 0.51, 95% CI 0.29-0.94). There was no difference in adjusted length of stay for young adults with severe sepsis (adjusting for CCC, Event Time Ratio [ETR]: 1.14, 95% CI 0.94-1.38; adjusting for CCI, ETR: 1.09, 95% CI 0.90-1.33). Conclusions: Young adults with severe sepsis experience higher adjusted odds of mortality when treated in PICUs versus MICU/SICUs. However, there was no difference in length of stay. Variation in mortality is likely due to significant differences in the patient populations, including comorbidity status.

Outcome of young adult patients with very-high-risk acute lymphoblastic leukemia treated with pediatric-type chemotherapy – a single institute experience

Adult patients of acute lymphoblastic leukemia (ALL) with very high-risk (VHR) characteristics have an inferior outcome, and allogeneic hematopoietic stem cell transplantation (HSCT) is usually performed. In contrast, VHR pediatric patients can be treated effectively with minimal residual disease (MRD)-guided pediatric protocols and HSCT are not always needed. We retrospectively reviewed young adult ALL VHR patients treated with the pediatric-type (TPOG-ALL-2002 VHR) regimen in our institute from 2008 to 2019 and compared the event-free survival (EFS) with patients treated with an adult-type regimen (Hyper-CVAD alternating with high dose methotrexate and cytarabine). We identified 16 patients treated with the TPOG and 11 treated with the Hyper-CVAD regimen. Philadelphia chromosome-positive (n=10) and T-cell immunophenotype (n=11) are the most common VHR features. Compared with the Hyper-CVAD group, patients treated with the TPOG regimen showed a trend toward better EFS with a hazard ratio (HR) of 0.42 (p=0.16). Compared with untransplanted patients, HSCT showed a positive trend in the Hyper-CVAD (HR 0.22, p=0.12) but not in the TPOG group (p=0.37). Untransplanted patients treated initially with the hyper-CVAD regimen had a significantly worse outcome than the TPOG regimen (HR 4.19, p<0.05). In the TPOG group, patients with negative MRD at the end of consolidation had a significantly better outcome (HR 0.12, p=0.03). Young adult VHR patients can be effectively treated with the TPOG-ALL-2002 protocol, and those who achieved MRD negativity before the end of consolidation have a good outcome without allogeneic HSCT.

Clinicopathologic Features, Mutation Spectrum and Clinical Outcome of Complex/Monosomy Karyotype AML in Young Adult Patients in Hong Kong

Objectives: Acute myeloid leukemia (AML) with complex/monosomal karyotype (CK/MK) is associated with poor response to conventional chemotherapy and clinical outcome. This study examined the clinicopathologic features, mutation spectrum and clinical outcome of young adult patients with CK/MK AML treated with a uniform protocol in Hong Kong.Methods: Young adult patients (18-60 year old) with CK/MK-AML treated in 7 regional hospitals in Hong Kong from January 2003 to July 2016, were analyzed retrospectively. CK-AML was defined as those with ≥ 3 clonal abnormalities. MK-AML was defined as those with ≥ 2 autosomal monosomies or single autosomal monosomy and at least one structural abnormality. Treatment comprised induction (7+3 regimen or equivalent) and consolidation (high-dose cytarabine). Relapsed or refractory patients received salvage chemotherapy. All patients who achieved complete remission (CR) were referred to allogeneic hematopoietic stem cell transplantation (HSCT) from HLA identical sibling or matched unrelated donors. Mutation spectra of their diagnostic bone marrow samples were analyzed by MiSeq NGS with the TruSight Myeloid sequencing panel targeting 54 genes covering full coding sequence of 15 genes and exonic hot spot for 39 genes. Leukemia-free survival (LFS) and overall survival (OS) were evaluated by Kaplan-Meier curves and compared by log-rank test. Cox proportional hazard model was used in univariate and multivariate analyses.Results: Seventy-six patients (41 men and 35 women) with CK/MK-AML were analyzed. Their clinicopathologic features as well as mutation spectra of 45 patients whose diagnostic marrow were examined by NGS were shown in Table 1. A total of 116 genetic mutations were found (median 2 mutations, range 1-7 mutations per patient). Five patients died before induction and 2 refused treatment. Of the 69 patients who received induction chemotherapy, CR was achieved in 48 of them (70%) after one (N=33) or two (N=15) courses. After 1, 2 and 5 years, LFS was 41%, 26% and 18% and OS was 49%, 20% and 12% respectively. There was no significant association between CR and clinicopathologic features including age, gender, presenting WCC, percentage of marrow and circulating blasts, specific subtypes and number of cytogenetic abnormalities, number of gene mutations and presence of TP53 mutations. In univariate analysis, HSCT at CR1 was significantly associated with longer LFS with a hazard ratio (HR) of 6.1 (range, 2.4-15.7, p <0.001). Achievement of CR1, absence of -17/17p- and HSCT at CR1 were significantly associated with OS with HRs of 8.3 (range 4.4-15.8, p <0.001), 3.2 (range, 1.7-3.2, p<0.001) and 5.7 (range, 2.4-13.5, p <0.001) respectively. TP53 mutations, number of karyotypic abnormalities and mutations were not predictive of CR, LFS or OS in this cohort. In multivariate analysis, achievement of CR1 (HR 4.3, 2.2-8.2, p <0.001), absence of -17/17p- (HR 3.0, 1.5-5.9, p=0.002) and HSCT at CR1(HR 5.8, 2.4-13.7, p <0.001) were associated with superior OS.Conclusion: Karyotypic abnormalities particularly the presence of -17/17p-, the achievement of initial remission upon induction and timely HSCT are important factors associated with disease control and survival in CK/MK AML. The role of gene mutations, particularly TP53, RUNX1 and DMNT3A as well as the best maintenance strategies post HSCT would have to be further evaluated. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Molecular Characterization and Clinical Outcomes of Young Adult Patients (≤45 years old) with Philadelphia-Negative Myeloproliferative Neoplasms

Background: Polycythemia vera (PV), Essential Thrombocytosis (ET) and Primary Myelofibrosis (PMF) are Myeloproliferative Neoplasms (MPNs) with median age at diagnosis of ~56-70 years old. However, around 10%-15% of cases are diagnosed during young adulthood and there are scanty data about their molecular profile and its implications in clinical outcomes. Objective: To analyze the clinical and molecular characteristics of young adult patients (≤45y.o.) with MPNs (Y-MPN) and to correlate them with clinical features and outcomes. Material and Methods: This is a retrospective single-center study including MPN patients diagnosed below the age of 45 years. Molecular characterization was performed using DNA from granulocytes at diagnosis or before the start of cytoreductive therapy. JAK2V617F was assessed by quantitative allele-specific PCR and CALR mutations by fragment analysis of exon 9. Further molecular profiling was performed by next generation sequencing (NGS) with a custom panel of 25 myeloid-associated genes (ASXL1, CALR, CBL, CSF3R, DNMT3A, ETV6, EZH2, IDH1, IDH2, JAK2, KIT, KRAS, MPL, NRAS, PRPF8, RUNX1, SETPB1, SF3B1, S2HB3, SRSF2, STAG2, TET2, TP53, U2AF1 and ZRSR2) using Illumina technology. Pathogenic mutations in genes previously related with poor outcomes (ASXL1, EZH2, IDH1, IDH2, SRSF2 and U2AF1) were named as Mutations of Adverse Significance (MAS). Molecular alterations were correlated with diagnosis, progression to PV post ET (PVpET), progression to MF post PV/ET (MFpPV/ET), start of cytoreduction and major thrombotic events (MTE). Time to progression (TTP) and overall survival (OS) were calculated from diagnosis to progression (ELN criteria) and to last visit. Results: From 646 MPN followed in our clinic, 109 (17%) cases were Y-MPN; females 72 (66.1%). At diagnosis the median age was 35 y.o. (9-45). 23 patients (21%) were PV, 91% carried JAK2V617F, 4% (1) carried an exon-12 JAK2 mutation and 1 was JAK2V617F and exon-12 negative. 84 cases (77.1%) were ET, 53.5% (45) JAK2V617F, 25% (21) CALR, (52% type-1 mutation, see table) and 21.4% (18) triple negative (TN). There was 1 PMF with CALR type-1 mutation. No MPL canonical mutations were found. ET was predominantly diagnosed in females (M/F: 26/58). Regarding clinical variables, we found a high proportion of ET-JAK2V617F with high LDH values, higher platelet count for CALR-ET and ET-TN patients (967 and 978 vs 728 for ET-JAK2V617F, p=0.03) and higher frequency of MTE at or before diagnosis for JAKV617F cases (p=0.001). The mean follow-up was 152 months (SD +/-10.4); 16 progressions were registered (PFS 305 months); 8 patients to MFpPV/ET and 8 ET-JAK2V617F to PVpET. An increase in the VAF of JAK2V617F was observed at the time of progression either to PVpET or to MFpET/PV (see table). Seven MTE were registered during this time, 3 in JAK2V617F, 2 in CALR type-1, 1 in exon-12 and 1 in a TN case. 38 (34.8%) cases started cytoreduction, with median time to cytoreductive therapy of 251 (172-330) months; JAK2V617F cases started cytoreduction more often (p=0.04) than patients with other genotypes. No progression to AML nor deaths were recorded. The NGS panel was performed in 102 (93.5%) cases. Pathogenic mutations in non-driver genes were found in 41.2% (42) of cases, being TET2 (7%), ASXL1 (6%) and DNMT3A (5%) the most frequently mutated genes. Also, in 28.4% (29) variants of unknown significance (VUS) were found, involving TET2 (6%), SETBP1 (4%), SH2B3 (5%), and JAK2 (4%) among others. The mutations in SH2B3 (1 pathogenic, 5 VUS) were more frequent in JAK2V617F patients and those in DNMT3A were more common in PV patients. The presence of mutations in non-driver genes (pathogenic or VUS) did not correlate with MTE before or after diagnosis, the start of cytoreduction nor clonal progression. Regarding the 19 TN cases, in 7 (36.8%) one or more non-canonical pathogenic variants implicating MPL, JAK2 and TET2 genes were found. Finally, 8 patients (7.8%) harbored a MAS, of which 3 progressed to MF (2 CALR to MF and 1 ET-JAK2V617F to PVpET); TTP was similar to the rest of the cohort. Conclusions: Our data show that 41% of Y-MPN patients harbor pathogenic mutations in non-driver genes. There was no correlation between their presence and clonal progression, major thrombotic events or overall survival. Mutations of adverse significance did not predict major clinical outcomes. Monitoring of JAK2V617F allele-burden can help to predict progression to MFpPV/ET or PVpET. Disclosures Andrade-Campos: Sanofi-Genzyme: Consultancy, Speakers Bureau; Takeda-Shire: Speakers Bureau; Celgene-BMS: Consultancy. Fernández:Roche: Consultancy, Speakers Bureau. Salar:Janssen: Speakers Bureau; Roche: Speakers Bureau; Celgene: Speakers Bureau. Bellosillo:Qiagen: Consultancy, Speakers Bureau; Roche: Consultancy, Research Funding, Speakers Bureau.

A nomogram predicting the prognosis of young adult patients diagnosed with hepatocellular carcinoma: A population-based analysis

BackgroundFew studies have reported the clinical characteristics and outcomes of young adult patients diagnosed with hepatocellular carcinoma (HCC). This study aimed to formulate a nomogram to predict the prognosis of young adult HCC patients.MethodsYoung adult patients diagnosed with HCC from 2004 to 2015 were screened from the Surveillance, Epidemiology, and End Results (SEER) database. Based on the multivariate analysis results, a nomogram was constructed. The concordance index (c-index) and calibration were used to assess the predictive performance of the nomogram. The clinical benefit was measured by using decision curve analysis (DCA).ResultsThe mean follow-up time of the patients was 25.0±34.0 months. Gender, race, AFP level, Edmondson–Steiner classification, treatment and TNM stage were selected as independent prognostic factors and integrated into the nomogram. The c-indexes of the two sets were 0.786 and 0.775, respectively. The calibration curves showed good agreement between the nomogram-predicted probability and the actual observations. Furthermore, the DCA indicated that the nomogram had positive net benefits compared with the conventional staging system.ConclusionsThe nomogram could accurately predict the prognosis of young adult HCC patients.

Pars Repair in Isthmic Spondylolysis in the Young Adults

Abstract Background Data: Spondylolysis is the main identifiable cause of low back pain in children and adolescents. The fifth lumbar vertebra (L5) is the most common site for spondylolysis. The cause of spondylolysis in these patients is attributed to repetitive stress of the pars interarticularis with subsequent microfracture;it is believed that an inherited genetic pars weakness can make an individual more susceptible to spondylolysis.There are varieties of surgical techniques in the treatment of spondylolisthesis whether the traditional surgical fusion and instrumental fixation or the direct pars repair if no evident slippage, disc degeneration or canal stenosis. Purpose: Evaluations of the efficacy of pars repair as regard bony fusion, preservation of motion segment with no adjacent level disease. Patients and Methods: our study was conducted on10 patients with diagnosed isthmic spondylolysis.Three males and seven females were operated (between 2016- 2018) by direct pars repair using smile face shaped rod technique (V shaped rod technique) with insertion of iliac crest bone graft at the site of the defect bilaterally to enhance bony fusion at the fracture site. Age less than 30years, Weight less than 80kg, back pain not responding to conservative treatment. No slippage or less than 2mm, healthy disc space not degenerated, no disc herniation or canal stenosis, no previous disc operation, preserved sagittal balance and lumber lordosis. Results: All cases were assessed clinically and radiologically over one year to assess the improvement in back pain using RMQ and to assess bony fusion radiologically through PXR and CT lumbosacral spine. Good outcome was achieved in seven cases (70% of patients) with significant improvement in back pain and RMQ. Two cases (20% of patients) had fair outcome with occasional back pain occur with sports and strenuous activities. 1 case (10% of patients) had poor out come as the patient exposed to back trauma that lead to fracture of the L5 screw and operated again for traditional surgery with 4 screws, 2 rods and cage placemen. Par bony fusion was sound in all cases except one patient that was subjected to direct back trauma 3 months following surgery and had one screw fracture, that required redo surgery with formal fixation using 4 screws, 2 rods and intervertebral cage Conclusion: Direct pars repair can provide good functional outcomes in young adult patients with isthmic spondylolysis.

Operativno lečenje preloma vrata butne kosti primenom kanuliranih zavrtnja sa i bez ubacivanja plazme obogaćene trombocitima kod mlađih osoba - komparativna studija

Many studies have evaluated the effect of platelet rich plasma (PRP) in the treatment of non-union fractures but few studies have investigated their effect on the union of femoral neck fractures or their functional outcome in young adults. The aim of this study was to evaluate the union time and functional outcome in young adult patients with femoral neck fracture managed by three cannulated screws injected with PRP and those managed by fixation only. This prospective study included 24 patients diagnosed with femoral neck fractures within 24 hours of presentation. Twelve cases in group A were managed by closed reduction and three cannulated screws fixation injected with PRP; twelve patients in group B were managed only by closed reduction and three cannulated screws fixation. Results revealed a significant difference between the two groups (p = 0.004) with regard to mean union time, (group A - 3.9 months, group B - 4.8 months). No statistically significant differences were found in functional outcomes between groups, as measured by the Harris Hip Score and Visual Analogue Scale.

Prediabetes Is Associated with Unfavorable Outcome in Young Adult Patients with Ischemic Stroke

Prediabetes has been associated with unfavorable short-term outcome in patients with ischemic stroke (IS). However, its effect in the subset of young adult patients has not been fully assessed. Our aim was to study the association between prediabetes and 3-month outcome in young adult patients with IS. This is a retrospective analysis of consecutive patients aged 18-55 years with a clinical diagnosis of acute IS between January 2010 and December 2016. According to their glucose profile, patients were divided in 3 groups: normal glucose metabolism, prediabetes, and diabetes. The outcome at 3 months was assessed by the modified Rankin Scale (mRS) and dichotomized as good (mRS score ≤2) and poor (mRS score >2) outcomes. A total of 247 patients were included, the median age was 49 years (interquartile range 42-53), and 144 (58.3%) were men. Prediabetes was diagnosed in 79 patients (32.0%) and diabetes was diagnosed in 45 patients (18.2%). Prediabetic (adjusted odds ratio [OR] 2.4, 95% confidence interval [CI] 1.1-5.1, P = .031) and diabetic (adjusted OR 2.8, 95% CI 1.3-6.1, P = .020) patients had a worse prognosis at 3 months. A statistical significant shift in the distribution of the mRS score at 3 months was found in prediabetic (adjusted OR 2.5, 95% CI .3-1.5, P = .002) and diabetic (adjusted OR 3.74, 95% CI .5-2.2, P = .002) patients. In young adults with IS, prediabetes and diabetes increase the risk of unfavorable outcome at 3 months.

Survival Benefit of Intravenous Busulfan (120 mg/M2) and Fludarabine Myeloablative Regimen for Treatment of Myeloid Malignancies

Background: Intravenous fludarabine and busulfan 130 mg/m2 (Flu/Bu) conditioning regimen has induced the long term survival with a low treatment related mortality rate. However, there have been few reports on long term survival of patients undergoing allo-HSCT with intravenous Flu/Bu regimen. Therefore, we conducted a retrospective study of 42 patients diagnosed with myeloid malignancies received allo-HSCT with intravenous fludarabine and busulfan (120 mg/m2) regimen between 2006 and 2015 at Ramathibodi hospital. The aim of our study was to observe the long term survival and the complication after transplantation. Findings: Thirty- four, three and five patients were AML, MDS and CML-CP respectively. With a median followup of 95 months, 1- year EFS and 8- year EFS were 82 and 70% respectively. Overall survival (OS) rate at 1 and 8 years were equally observed in 88%. Patient younger than age 45 years had significantly longer OS than patients aged 45 years and older (96 vs 70%, p=0.019). Eight- year OS in AML, MDS and CML were 88, 67 and 100% respectively. Acute and chronic graft versus host disease were found in 29 and 46.3% of 41 evaluable patients respectively. Whereas the rates of sinusoidal obstruction syndrome, sepsis, CMV reactivation, cyclosporine and tacrolimus induced thrombotic microangiopathy were 2, 10, 12, 5 and 2% respectively. Non- relapse mortality rate at day +100, 1 and 8 year were only 9.5, 13.8 and 13.8% respectively. There was no neurological toxicity, severe mucositis, secondary malignancy or therapy related MDS syndrome in this study. Conclusion: Allogeneic hematopoietic stem cell transplantation with intravenous fludarabine and busulfan at the dose of 120 mg/m2 was well tolerated and demonstrated impressive treatment outcomes in young adult patients diagnosed with myeloid malignancies.

Pediatric-Like Therapy for Adults with ALL

Ten years ago, the first studies comparing the results of adult versus pediatric protocols in adolescents with acute lymphoblastic leukemia (ALL) clearly showed that differences in ALL genetics and treatment tolerance could not be the only reasons for the worse outcome observed in adults with this disease as compared to children. It became evident that intensified pediatric chemotherapy regimens could be associated with better response rates and longer survival in adults as well. During the last decade, the use of pediatric-like or pediatric-inspired protocols in adults allowed markedly improving the outcome of young adult patients aged up from 40years to 60years, confirming this initial observation. Administration of pediatric-like therapy in adults is now associated with estimated 5-year overall survival comprised between 60% and 70%. In this new context, the risk factors and the place of stem cell transplantation need to be reassessed.

Acute Lymphoblastic Leukemia: Age and Biology

Acute lymphoblastic leukemia (ALL) is the most frequent neoplasm in children, while being relatively rare in adults. The outcome of children with ALL is far superior than that observed in adults, whose survival rates generally do not exceed 40%. A retrospective analysis recently carried out on a large series of cases enrolled in the AIEOP and GIMEMA protocols for the treatment of pediatric and adult ALL has documented specific differences among the various age cohorts examined, particularly in terms of incidence of molecular rearrangements, with the BCR/ABL rearrangement being detected in more than half of patients in the 6th decade of life. These findings highlight the importance of a precise diagnostic screening at all ages, since elderly patients might benefit more from targeted approaches, that are associated with less toxic effects. Furthermore, extended biologic approaches aimed at identifying novel therapeutic targets should be regarded as a main goal to refine our therapeutic armamentarium.Finally, the introduction of pediatric-like protocols is progressively changing the outcome of young adult patients, although an important caveat is represented by the comorbidities and toxic effects associated with more aggressive chemotherapy; therefore, patients' fitness should always be carefully considered.

Comparison of Surgical and Nonsurgical Treatment of Bilateral Condylar Fractures Based on Maximal Mouth Opening

This study presents a comparative analysis of the open surgical and nonsurgical treatment of patients with bilateral condylar fractures. Sixty-seven (67) patients were treated, and the completed data on 55 patients were reviewed to compare both therapeutic modalities, which consisted of nonsurgical and surgical treatment in 37 and 18 patients, respectively. In the nonsurgical group, 23 patients (23/37, 62%) had normal mouth opening. Functional success rate was 79% (15/19) and 44% (8/18) in young adult patients (-29yrs) and older patients (30+yrs), respectively, and there was a significant difference of outcome between the two groups. In nonsurgically treated young patients with disorders, bilateral dislocation and existence of concomitant mandibular fractures were commonly observed. In the open surgical group, seven (7/11, 64%) young adult and three (3/7, 43%) older patients gained normal mouth opening, and no significant difference was observed. Additionally, there was no difference between non-surgical and surgical treatment in any category. Patients undergoing rigid fixation benefited from restoring maximum mouth opening, although there was no significant difference between the rigid and non-rigid fixation groups. Based on these findings, nonrigid fixation should be avoided, and rigid fixation might improve outcome in young adult patients with severe fracture pattern, such as bilateral dislocation and concomitant mandibular fracture.

Primary Trabeculectomy in Young Adults

Younger patients are thought to have a poor surgical prognosis after trabeculectomy. The authors investigate the surgical outcome of young adult patients after primary trabeculectomy. The authors reviewed the charts of all patients 15 to 40 years of age who had undergone primary trabeculectomy without the use of antimetabolites between January 1985 and January 1992 at Wills Eye Hospital. Failure was defined before the data collection as intraocular pressure (IOP) more than 25 mmHg without medication, IOP more than 21 mmHg with medication, or when further glaucoma surgery was indicated. Patients in whom preoperative IOPs were 21 mmHg or lower were classified as successes when the IOP was reduced by at least 33% of the preoperative measurement. After a mean follow-up of 36.8 +/- 21.8 months, among the 31 patients with uncomplicated glaucomas (juvenile, pigmentary, low tension, chronic angle closure), 26 (83.9%) were considered successes. After a mean follow-up of 42.3 +/- 26.5 months, among the 11 patients with other types of glaucoma (inflammatory, traumatic, associated with irido-corneal endothelial syndrome or mesodermal dysgenesis), 7 (63.6%) were considered successes. The success rate of the uncomplicated group compares favorably with the 75% to 90% success rates of trabeculectomy commonly cited for primary glaucomas in older patients. Primary trabeculectomy in young adults may have a favorable outcome despite no antimetabolite therapy.