Reoccurrence Rates Research Articles

8409 Thyroid Nodules A to V: A Discussion on Thyroid Nodules and a Case Report of a Rare Thyroid Arteriovenous Malformation

Abstract Disclosure: M. Townsend: None. M. Brennan: None. C. Kazmierczak: None. P. Czako: None. Introduction: Thyroid nodules are an increasingly common finding on imaging, and the differential is broad. Arteriovenous malformations (AVMs) are a very rare cause of thyroid lesions, with only 6 reported cases to date. Given their scarcity, there is a lack of information regarding these lesions and how they are diagnosed and managed. Our case aims to address these gaps in information. Case: A 58-yo female with a history of hypertension was found by her PCP to have an enlarged left thyroid lobe with a new left sided bruit and palpable thrill. She had undergone prior thyroid ultrasonography for the enlarged left thyroid lobe which noted dilated and tortuous vascular structures at the posterior aspect of the left thyroid consistent with varices. These were being monitored clinically. Thyroid function tests were all normal. Due to concern for atherosclerotic disease, carotid ultrasound was obtained and showed patent carotid arteries with a large left sided thyroid mass. CTA of the neck revealed the mass to be a large (6.0 x 3.0 x 2.4 cm) AVM centered at the left thyroid gland. She underwent diagnostic angiography that confirmed the size of the mass and showed predominant arterial supply from the left superior thyroidal artery as well as bilateral inferior thyroidal arteries. Since the patient was asymptomatic with no reported neck pain, dysphagia or dyspnea, non-operative management with angioembolization was pursued given the risk of significant blood loss with surgical intervention. Following angioembolization, the results and adequacy of treatment are to be followed with repeat imaging given the high risk of reoccurrence. Discussion: AVMs of the thyroid are a very rare but clinically significant cause of thyroid lesions. Left untreated, they can grow in size and lead to compression of the esophagus or trachea, serious bleeding and high output heart failure. Their presentation is often non-specific and on routine thyroid imaging they can be difficult to differentiate from malignant tumors or varices, as in the case of our patient. Management prioritizes embolization, either alone or in conjunction with surgery, depending on the clinical scenario. Regardless of the treatment modality, reoccurrence rates remain high. Conclusion: Our case aims to add to the available information about thyroid AVMs and discuss the clinical presentation, challenges in diagnosis, imaging findings and treatment modalities available to manage these lesions. Presentation: 6/2/2024

Abstract 5745: Electrosprayed minocycline and temozolomide-loaded PLGA microparticles for the treatment of glioblastoma

Abstract Glioblastoma multiforme (GBM), the most common and aggressive form of malignant brain tumor, leads to poor prognoses with high rates of reoccurrence and low survival rates, therefore, it is vital to explore alternative treatments for GBM. Minocycline, a commonly used antibiotic and tetracycline derivative, has proven anti-angiogenic effects and the ability to inhibit tumor growth, making it an effective GBM treatment. Temozolomide is an alkylating antineoplastic agent and the current first-choice chemotherapy agent for GBM. Poly(lactic-co-glycolic acid) (PLGA) is widely used as a biomaterial for drug delivery due to its inert properties, great biocompatibility and versatility and has been approved by the FDA. Therefore, the objective of this project is to fabricate electrosprayed minocycline- and temozolomide-loaded PLGA microparticles with optimal morphology, drug loading, loading efficiency, and drug release kinetics for the treatment of GBM. The microparticles were fabricated by electrospraying vertically with a 2ml/hr flow rate, 14kV voltage, 20 cm distance for minocycline and a 10ml/hr flow rate, 10kV voltage, 10 cm distance for temozolomide with both collected on a copper/glass plate. The parameters that were investigated were the chamber humidity, duration of spraying, and the addition of polyethylene glycol (PEG), a hydrophilic polymer. To determine the microparticles’ morphology, bright-field microscopy and scanning electron microscopy (SEM) were used. The absorbance measurements at 350 and 327 nm were used to determine drug loading, loading efficiency, and release kinetics for minocycline and temozolomide, respectively. Microparticles with low chamber humidity and duration of spraying were more spherical, less aggregated and easier to collect for both drugs. The addition of PEG to minocycline-loaded microparticles led to higher drug loading and loading efficiency (4.02% ± 0.34, 64.30% ± 5.47 vs. 3.23% ± 0.29, 49.40% ± 4.49) as the PEG helps the solubilization of minocycline. Using acetonitrile instead of dichloromethane as the solvent, increased drug loading and loading efficiency (4.72% ± 0.76, 70.77 ± 11.43 vs. 2.37% ± 0.27, 35.62% ± 4.09) for temozolomide-loaded microparticles as more temozolomide can be solubilized in acetonitrile. Drug release kinetics demonstrated a burst release of minocycline in the first hour (65.46%). To decrease the burst release, the microparticles can be incorporated into a scaffold or depot. Overall, electrospraying is a promising method to fabricate drug loaded PLGA microparticles with high drug loading, loading efficiency, and right morphology and we determined optimal parameters to successfully fabricate electrosprayed drug loaded PLGA microparticles in the micron size range with high drug loading and loading efficiency compared to the often-used emulsion solvent extraction/evaporation for microparticle fabrication. Citation Format: Alma Rodriguez, Jaqueline Quintanilla, Juan Amieva, Marco A. Arriaga, Sean Nievera, Ivan Davila, Karen S. Martirosyan, Sue Anne Chew. Electrosprayed minocycline and temozolomide-loaded PLGA microparticles for the treatment of glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5745.

Associations between pre-infection serum vitamin D concentrations and Omicron COVID-19 incidence, severity and reoccurrence in elderly individuals.

Previous studies suggest a link between vitamin D status and COVID-19 susceptibility in hospitalised patients. This study aimed to investigate whether vitamin D concentrations in elderly individuals were associated with their susceptibility to Omicron COVID-19 incidence, the severity of the disease and the likelihood of reoccurrence during the era of the post-'zero-COVID-19' policies in China. In this retrospective study, participants were categorised into three groups based on their 25(OH)D concentrations: deficiency (< 20 ng/ml), insufficiency (20 to < 30 ng/ml) and sufficiency (≥ 30 ng/ml). The demographic and clinical characteristics, comorbidities and the incidence rate, reoccurrence rate and severity of Omicron COVID-19 were retrospectively recorded and analysed by using hospital information system data and an online questionnaire survey. China. 222 participants aged 60 years or older from a health management centre. Our findings revealed significant differences in the incidence (P = 0·03) and recurrent rate (P = 0·02) of Omicron COVID-19 among the three groups. Participants with lower 25(OH)D concentrations (< 20 ng/ml) exhibited higher rates of initial incidence and reoccurrence and a greater percentage of severe and critical cases. Conversely, individuals with 25(OH)D concentrations ≥ 30 ng/ml had a higher percentage of mild cases (P = 0·003). Binary and ordinal logistic regression models indicated that vitamin D supplementation was not a significant risk factor for COVID-19 outcomes. In the elderly population, pre-infection vitamin D deficiency was associated with increased susceptibility to incidence, severity of illness and reoccurrence rates of Omicron COVID-19.

1017 Transurethral Laser Ablation for Non-Muscle Invasive Bladder Cancer: A Service Validation

Abstract Aim Transurethral laser ablation (TULA) for non-muscle invasive bladder cancer (NMIBC) allows outpatient treatment of suspected bladder cancer re-occurrence whilst avoiding the risks of the general anaesthetic. The COVID pandemic limited operating capacity was therefore TULA was adopted in a tertiary centre hospital in the UK in order to continue treatment for appropriate cases. We aimed to assess remission free period, the laser energy usage and waiting time for patients since the service started. Method A retrospective service evaluation since December 2020 till May 2022. All patients who were listed for TULA were eligible. Exclusion criteria was incomplete data and patients who did not have NMIBC. Demographic data, listing time, remission free period and lasering usage were all recorded. Patients were risk stratified as per the EAU guidelines; patients were upstaged to the higher category if there was incomplete data to stage accurately. Statistical analysis was conducting using a one-way ANOVA. Results 183 patients underwent TULA; 165 patients were included. The mean age was 79 years. The mean time was listing to procedure was 77 days. 72 patients had not had a flexible cystoscope post TULA. There was no significant difference between remission rates and re-occurrence rates (p = 0.544) between risk categories (p = 0.96). Conclusions The re-occurrence rates following TULA did not vary depending on the risk of NIMBC, nor did the energy usage. Longer collection periods are required to ascertain if this alters with time. Further research is required to assess if earlier treatment of more aggressive forms of NMIBC allows for lower reoccurrence rates.

Concept of Marma Chikitsa in Diabetic Retinopathy

Nowadays, diabetic retinopathy is one of the main reasons people go blind in the world. Thus, encouraging researchers to look for strategies to stop its progression and provide effective treatment. Laser, photocoagulation, vitrectomy, etc. are used in treatment. They are beneficial for a brief period of time, but on the flip side, they have significant reoccurrence rates and cause discomfort to the person. Ayurveda's undiscovered riches can be discovered here to benefit humanity. One such undiscovered resource is Marma Chikitsa. Pressing Marma points releases energy blockages, eliminates excess Ama, facilitates easy energy flow, nourishes tissues, and produces endorphins and cortisol-like hormones, which in turn cause a calm shut-off FFF response and enhance blood circulation. All of these activities lead to improved performance in that specific area. With Pathya Ahara, a healthy diet, exercise, and the right medication, some Marma points, including Apanga, Avarta, Sthapni, Vidhura, Kurcha, Kurchshira, Indravasti, and Nabhi, that are associated with the eyes and others that promote better metabolism, can be very effective in slowing the progression of retinopathy. Marma Chikitsa may be a reliable, practical, and affordable adjuvant treatment for diabetic retinopathy.

Externally validated machine learning algorithm accurately predicts medial tibial stress syndrome in military trainees: a multicohort study

ObjectivesMedial tibial stress syndrome (MTSS) is a common musculoskeletal injury in both sporting and military settings. No reliable treatments exist, and reoccurrence rates are high. Prevention of MTSS is critical...

Applications of nanomaterials for gastrointestinal tumors: A review.

Nanotechnology is the emerging and advance field of research for the diagnosis and treatment of various diseases. With the development of nanotechnology, different nanoparticles are used in the treatment of cancer due to their unique optical properties, excellent biocompatibility, surface effects, and small size effects. Nanoparticles are the particles which have the particular size from 1 to 100 nm. These nanoparticles are zero dimension, one dimension, two dimension and three dimension etc. In present scenario a variety of research is focused on the tailored synthesis of nanoparticles for medicinal applications that can be used for cancer treatment based on the morphology, composition, interaction with target cell. The gastrointestinal (GI) tumors are found one of the deadest cancer types with highest reoccurrence rates. The diagnosis and treatment of gastrointestinal cancer is very challenging due to its deep location and complicated surgery. Nanotechnology provides fast diagnosis and immediate treatment for the gastrointestinal disease. A variety of nanomaterials are used for the diagnosis and treatment of GI disease. Nanoparticles target directly to the tumor cell as diagnostic and therapeutic tools facilitating the identification and removal of tumor cells. A number of nanoparticles are developed for the uses are quantum dots (QDs), carbon nanotubes (CNTs), metallic nanoparticles (MNPs), Dendrimers etc. This review article gives an overview of the most promising nanomaterials used for the diagnosis and treatment of GI diseases. This review attempts to incorporate numerous uses for the most current nanomaterials, which have great potential for treating gastrointestinal diseases.

Risk Factors and Outcomes of Bloodstream Infections Among People With Human Immunodeficiency Virus: A Longitudinal Cohort Study From 2000 to 2017.

BackgroundBloodstream infections (BSIs) among people with human immunodeficiency virus (PWH) remain a poorly studied source of morbidity and mortality. We characterize the epidemiology, microbiology, and clinical outcomes including reinfection, hospitalization, and mortality rates of both community-acquired and hospital-acquired BSI in PWH.MethodsWe identified all BSI, between January 1, 2000 and December 31, 2017 in PWH in care at Southern Alberta Clinic, by linking data from laboratory and clinical databases. Crude incidence rates per 1000 person-years for BSI and death were calculated. Cox proportional hazards models estimated crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) to conduct a risk factor analysis of BSI in PWH. Logistic regression models with generalized estimating equations estimated crude and adjusted odds ratios (aORs) to identify characteristics associated with 1-year mortality after BSI.ResultsAmong 2895 PWH, 396 BSI episodes occurred in 228 (8%) PWH. There were 278 (72%) Gram-positive and 109 (28%) Gram-negative BSI. People with human immunodeficiency virus with lower CD4 nadirs, higher Charlson comorbidity indices, and hepatitis C virus were at highest risk for BSI. Long-term all-cause mortality was greater in those experiencing BSI (HR, 5.25; 95% CI, 4.21–6.55). CD4 count <200 cells/mm3 measured closest to the time of BSI was associated with 1-year mortality after BSI (aOR, 3.88; 95% CI, 1.78–8.46). Repeat episodes (42%) and polymicrobial BSI (19%) were common.ConclusionsBloodstream infections continue to occur at an elevated rate among PWH with high reoccurrence rates and associated morbidity and mortality. To risk stratify and develop targeted interventions, we identified PWH at greatest risk for BSI. People with human immunodeficiency virus with low immunity at the time of BSI are at highest risk of poor outcomes.

Retrospective review of secondary prevention strategies for gastrointestinal bleeding and associated clinical outcomes in left ventricular assist device patients.

Gastrointestinal bleeding (GIB) is one of the most common bleeding complications associated with left ventricular assist devices (LVAD). Currently, there is no strong evidence or clear guidance for which secondary GIB prophylaxis strategy should be implemented after the discontinuation of aspirin. Our single-center study describes the outcomes of 26 LVAD patients who experienced a total of 49 GIB events: these individuals were either in Group-1 (lower INR target range) or Group-2 (lower INR target plus a hemostatic agent) as the secondary prophylaxis strategy. Each GIB event was considered an independent event. Outcomes assessed were bleeding reoccurrence rates, time to next GIB, acute GIB strategies, GIB-free days, thromboembolic events, survival, coagulation, and hematologic parameters. GIB reoccurrence rates were not statistically different: Group-1, 9 (40.9%), versus Group-2, 15 (55.6%); p=0.308. Danazol was utilized 81.5% of the time as the designated hemostatic agent. Additionally, no significant differences were observed with all of our secondary outcome measures for bleeding, ischemic events, or survival. While our study was not powered to assess the clinical outcomes related to survival and thromboembolic events, no discernable increased risk for ischemic events including pump thrombosis were observed. Our data suggest that a lower INR target range plus danazol does not confer any additional benefit over a lower INR target range only approach. The results of this report are hypothesis-generating and additional studies are warranted to elucidate the optimal antithrombotic strategy and role of hemostatic agents in reducing the risk of recurrent GIB events.

Adherence and Beliefs to Adjuvant Hormonal Therapy in Patients with Breast Cancer: A Cross-Sectional Study (Conference Paper) #

Breast cancer is the most common cancer among women over the world. To reducing reoccurrence and mortality rates, adjuvant hormonal therapy (AHT) is used for a long period. The major barrier to the effectiveness of the treatment is adherence. Adherence to medicines among patients is challenging. Patient beliefs in medications can be positively or negatively correlated to adherence. Objectives: To investigate the extent of adherence and factors affecting adherence, as well as to investigate the association between beliefs and adherence in women with breast cancer taking AHT. Method: A cross-sectional study included 124 Iraqi women with breast cancer recruited from Middle Euphrates Cancer Center. Morisky medication adherence scale (MMAS) and beliefs about medication questionnaires (BMQ) are used to assess adherence and beliefs respectively. Result: 25% of women were fully adherent (MMAS = 8). 83.06% of all women developed side effects from medications received. Side effects and unemployed women were significantly associated with non-adherence. Additionally, there is no significant association between beliefs in medications and adherence. conclusion The enormous percent of poor adherence caused by side effects suggests the need for interventions by educating patients about the importance of their treatment and how to overcome side effects.

Effectiveness of combined modulated ultrasound and electric current stimulation to treat diabetic foot ulcers.

The use of combined ultrasound and electrostimulation (CUSECS) as an adjunct therapy for diabetic foot ulcers (DFUs) is a relatively new concept. This study aimed to investigate if combined ultrasound and electrostimulation is an effective adjunctive treatment for hard-to-heal DFUs when compared with standard wound care. A randomised controlled pilot study design was used. Patients with hard-to-heal DFUs from two centres were sequentially randomised. For 8 weeks, the experimental group received CUSECS and standard wound care treatment twice a week. The control group received standard wound care treatment once a week. Wound changes were documented using photography, which also facilitated wound size measurement. Self-efficacy, economic cost, quality of life and reoccurrence rates were analysed as secondary objectives. The experimental group (n=6) achieved a higher rate of mean wound healing (mean difference (MD): 0.49) when compared to the control group (n=5, MD: 0.01). Two participants completed full healing in the experimental group and one in the control group. There were no statistically significant findings because of the small sample size. There were no direct adverse reactions to this therapy. Quality of life scores improved in the treatment group. There was no significant change in self-efficacy scores. Costs were higher in the experimental group; however, the healing rate was quicker, which could be extrapolated to cost reductions over time. Results suggest that CUSECS may be a useful adjunctive therapy for treatment of hard-to-heal DFUs. Further large-scale studies are needed to ascertain the effectiveness of CUSECS. The findings here are inconclusive but indicate that CUSECS may offer promise as a treatment.

Kinematic Characteristics of Male Runners With a History of Recurrent Calf Muscle Strain Injury.

BackgroundCalf muscle strain injuries are a common running injury affecting male runners and are known to have high reoccurrence rates. Currently, limited evidence exists investigating factors associated with this injury with no previous study investigating the running kinematics of male runners with a history of repeat calf muscle strain injuries.PurposeTo investigate whether male runners with a history of repeat calf muscle strain injury demonstrate differences in stance phase running kinematics when compared to healthy controls.Study DesignCase-control investigationLevel of Evidence3bMethodsStance phase kinematics were compared between 15 male runners with a history of calf muscle strain injury and 15 male control participants during treadmill running at 3.2m/s. Independent t-tests were used to compare differences in stance phase kinematic parameters between groups and effect sizes were calculated using Cohen’s d.ResultsThe group with a history of calf muscle strain injury demonstrated a significant 2.1⁰ and 3.1⁰ increase in contralateral pelvic drop and anterior pelvic tilt during mid stance. In addition, this group exhibited longer stance times and a more anterior tilted pelvis, flexed hip and a greater distance between the heel and centre of mass at initial contact. Large effect sizes, greater than 0.8, were observed for all differences. No significant differences were observed for ankle and knee joint kinematics between the groups.ConclusionThis is the first study to identify kinematic characteristics associated with recurrent calf muscle strain injury. While it is not possible to determine causality, the observed kinematic differences may contribute to recurrent nature of this injury. Specifically, it is possible that neuromuscular deficits of the hip and calf muscle complex may lead to increased strain on the calf complex. Rehabilitation interventions which focus on addressing pelvis and hip kinematics may reduce the demands placed upon the calf complex and could prove clinically effective.

Management of retinopathy of prematurity (ROP) in a Polish cohort of infants

Retinopathy of prematurity (ROP) is potentially blinding, but screening and timely treatment can stop its progression. The data on treatment outcomes of ROP from Central and Eastern Europe are scarce. Therefore, we aimed to analyze the latest results of ROP management in Poznan medical center to update the data from this world region. In the years 2016–2019, 178 patients (350 eyes) received treatment for ROP (6.1% of the screened population). The mean gestational age was 26 weeks (range 22–31 weeks), the mean birth weight was 868 g (range 410–1890 g). The most frequent ROP stage at treatment was zone II, stage 3 + (34.9%). As the first line of treatment, 115 infants (226 eyes, 64.6%) underwent laser photocoagulation (LP); 61 infants (120 eyes, 34.3%) received intravitreal ranibizumab injections (IVR); and 2 infants (4 eyes, 0.6%) were treated simultaneously with LP and IVR. One hundred twenty-six eyes (36%) of 63 patients required retreatment: 20.4% treated with LP and 66.7% treated with IVR. Retinal detachment occurred in 14 eyes (4%). The incidence of ROP, ROP requiring treatment, and reoccurrence rates are higher in the Polish population than in Western Europe and the USA. The identified treatment patterns find increasing use of anti-VEGF agents.

Design, synthesis and structure-activity relationship study of novel urea compounds as FGFR1 inhibitors to treat metastatic triple-negative breast cancer.

Triple-negative breast cancer (TNBC) is an aggressive type of cancer characterized by higher metastatic and reoccurrence rates, where approximately one-third of TNBC patients suffer from the metastasis in the brain. At the same time, TNBC shows good responses to chemotherapy, a feature that fuels the search for novel compounds with therapeutic potential in this area. Recently, we have identified novel urea-based compounds with cytotoxicity against selected cell lines and with the ability to cross the blood-brain barrier invivo. We have synthesized and analyzed a library of more than 40 compounds to elucidate the key features responsible for the observed activity. We have also identified FGFR1 as a molecular target that is affected by the presence of these compounds, confirming our data using in silico model. Overall, we envision that these compounds can be further developed for the potential treatment of metastatic breast cancer.

Lateralising DMMO (MIS) for simultaneous correction of a pes adductus during surgical treatment of a hallux valgus

The surgical correction of a hallux valgus deformity presenting with a pes adductus has long proven to be a difficult undertaking. The medial shift of the metatarsal bones limits the scope for surgical correction and leads to inherently high reoccurrence rates. Current invasive treatments often give rise to profound soft tissue trauma and prolonged swelling, while requiring strict relief from weight-bearing in the affected foot.In this paper, it is aimed to introduce an easy and useful modification of the Distal Metatarsal Minimal-invasive Osteotomy (DMMO) to perform the effective, simultaneous correction of a pes adductus during surgical treatment of a hallux valgus. We followed-up 143 patients with a hallux valgus and simultaneous pes adductus deformity who underwent one of three additional interventions contemporaneous to the lateralising DMMO:1.mini-open Lapidus arthrodesis (Hybrid LAP)2.percutaneous, proximal MT 1 closing wedge-osteotomy (pCLW)3.percutaneous Chevron and Akins (pCA)The assessment of radiological and clinical outcomes after a follow-up period of 12-25 months showed a sustained and effective correction of the pes adductus with a well-aligned hallux. The surgery was characterised by a low incidence of postoperative complications and high patient satisfaction while allowing for pain-adapted, post-operative weight-bearing.Level of Clinical Evidence: 3.

Our Laparoscopic Surgical Technique and Experience in Treating Pediatric Inguinal Hernia Over the Past Decade.

Background:Over the past decade, laparoscopic hernia repair was the most performed operation in our department. Equally, it compromises 15% of all pediatric operations performed. We aim, in this study, to review all the cases performed and extrapolate important information like reoccurrences, the incidence of metachronous inguinal hernia, complications amongst other information.Material and Methods:All patients under the age of 18 whom underwent elective laparoscopic hernia repair between 03/01/2007 till the 18/05/2016 were included in our study. We recorded important clinical features and studied their post-operative follow up. Equally reoccurrences, the incidence of metachronous inguinal hernia, complications and other parameters were recorded and studied.Results:A total of 916 patients were operated on during the defined study period. There was a 0.17% reoccurrence rate and a 0.46% incidence of metachronous inguinal hernia. Equally a contralateral patent processus vaginalis was diagnosed and closed in 17.10%. There were no postoperative complications and we had a 0% postoperative hydrocele rate.Conclusion:Laparoscopic hernia repair is safe and carries all the benefits of minimally invasive surgery. We recommend that it is offered to patients and would like to refute previously claimed reports that it carries a higher reoccurrence rate or takes a long time to perform. Our reoccurrence rate of 0.17% is actually lower than many published reoccurrence rates after open repair.

LEFT VENTRICULAR NONCOMPACTION, GARDNER SYNDROME, AND DESMOID TUMORS, A GENETIC CONNECTION?

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Desmoid tumors are rare, fibrous tumors accounting for only 0.03% of neoplasms. They are locally invasive and associated with high reoccurrence rates. Left ventricular non-compaction (LVNC) is the arrest of normal cardiac compaction during embryonic development characterized by left ventricular trabeculae, intertrabecular recesses and a thin compacted layer. LVNC can result in left ventricular impairment, cardiac arrhythmia and embolic disease. LVNC has a prevalence of 0.05% in the adult population and is associated with genetic syndromes such as Noonan or Barth. CASE PRESENTATION: A 33-year-old male with a history of Gardner’s Syndrome, desmoid tumors, hypertension, non-ischemic cardiomyopathy is evaluated for heart failure. Patient’s symptoms were consistent with NYHA Class III. Patient was prescribed guideline-directed medical therapy (GDMT) and referred for echocardiogram. Echocardiogram revealed an ejection fraction of 40-45% with heterogeneous calcifications within the left ventricular myocardium. Cardiac MRI was ordered for further evaluation. MRI revealed mild dilation and global hypokinesis of left ventricle with ejection fraction of 31%. Trabeculations were seen at the distal aspect of the left ventricular myocardium along with focal areas of perfusion defects consistent with calcifications. Findings were concerning for LVNC. The MRI also detected a large anterior chest wall mass measuring 20x9cm consistent with a desmoid tumor (Figure 1). Patient was continued on GDMT for heart failure and referred to cardiothoracic surgery for evaluation of tumor removal. DISCUSSION: LVNC is diagnosed based on left ventricular morphology. Echocardiogram is the best initial test for evaluation but cardiac MRI provides a better assessment of the severity of LVNC. LVNC predisposes patients to left ventricular systolic failure, malignant arrhythmias, and thrombotic events. Management of LVNC involves goal directed medical therapy for heart failure, anticoagulation, and ICD based on guidelines for nonischemic cardiomyopathy. However no specific guidelines for treatment of LVNC exist. Management of desmoid tumors involve surgical resection to negative margins to minimize reoccurrences. Radiotherapy is used as adjuvant therapy in cases of incomplete resection. CONCLUSIONS: Although LVNC is associated with genetic syndromes, no connection to Gardner’s Syndrome or desmoid tumors could be found in the literature. The presence of these 3 rare genetic diseases in one individual suggest that there may be a genetic link. Reference #1: Akinseye OA, Ibebuogu UN, Jha SK. Left Ventricular Noncompaction Cardiomyopathy and Recurrent Polymorphic Ventricular Tachycardia: A Case Report and Literature Review. Perm J. 2017;21:17-045. Reference #2: Courtney E. Bennett and Ronald Freudenberger, “The Current Approach to Diagnosis and Management of Left Ventricular Noncompaction Cardiomyopathy: Review of the Literature,” Cardiology Research and Practice, vol. 2016, Article ID 5172308, 7 pages, 2016. https://doi.org/10.1155/2016/5172308. Reference #3: Bölke E, Krasniqi H, Lammering G, et al. Chest wall and intrathoracic desmoid tumors: surgical experience and review of the literature. Eur J Med Res. 2009;14(6):240-3. DISCLOSURES: no disclosure on file for Francecso Franchi; No relevant relationships by Aaron Richardson, source=Web Response No relevant relationships by Jose Rivas, source=Web Response

Adaptive treatment allocation for comparative clinical studies with recurrent events data.

In long-term clinical studies, recurrent event data are sometimes collected and used to contrast the efficacies of two different treatments. The event reoccurrence rates can be compared using the popular negative binomial model, which incorporates information related to patient heterogeneity into a data analysis. For treatment allocation, a balanced approach in which equal sample sizes are obtained for both treatments is predominately adopted. However, if one treatment is superior, then it may be desirable to allocate fewer subjects to the less-effective treatment. To accommodate this objective, a sequential response-adaptive treatment allocation procedure is derived based on the doubly adaptive biased coin design. Our proposed treatment allocation schemes have been shown to be capable of reducing the number of subjects receiving the inferior treatment while simultaneously retaining a test power level that is comparable to that of a balanced design. The redesign of a clinical study illustrates the advantages of using our procedure.

Molecular Mechanism of Protein Kinase A in Fibrolamellar Hepatocellular Carcinoma

Fibrolamellar Hepatocellular Carcinoma (FL‐HCC) is a rare form of liver cancer that affects adolescents and young adults without a prior history of liver disease. Chemotherapy is ineffective in treating FL‐HCC, and surgical resection of the primary tumor and metastases is currently the only semi‐effective treatment. Reoccurrence rates in FL‐HCC are extremely high.A 400kB deletion in chromosome 19 results in the fusion of the first exon of a heat shock protein, DNAJB1, with the catalytic subunit of protein kinase A, PRKACA (1). The new chimeric protein, DNAJB1‐PRKACA, retains the full catalytic activity of protein kinase A. We have performed partial biophysical characterization of DNAJB1‐PRKACA in comparison to PRKACA. Our preliminary results indicate the structural stability of DNAJB1‐PRKACA may differ from that of PRKACA. We also report the DNAJB1‐PRKACA chimera forms a stable complex with its regulatory domains, and differences in structural stability may extend to the chimera/regulatory domain complex. Surface plasmon resonance (SPR) does not reveal any difference in the binding affinity of DNAJB1‐PRKACA and wild type PRKACA to their Regulatory subunit type Iβ.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Sitting position awake craniostomy with drainage for chronic subdural hematoma: A viable alternative?

Background/Aim. Chronic subdural hematoma (CSDH) is one of the most frequent neurosurgical conditions with an overall incidence ranging from 1.72 to 20.6 per 100,000 persons per year. The surgical procedure for CSDH is relatively simple and usually performed in the supine position. Reported reoccurrence rates range from 11.7% to 28%. Postperative pneumocephalus was previously identified as a sole predictor of reoccurrence. The aim of this study was to assess the advantage of the procedure in the sitting position in patients with CSDH and a possible impact on the reoccurrence rate. Methods. The study included 31 patients who underwent awake craniostomy with closed system drainage for CSDH (16 in supine and 15 in sitting position) in our department from December 2016 to March 2018. Results. A total of 22 males and 9 females were included in the study. The overall reoccurrence rate was 19% (22% and 18% in females and males, respectively). The re-occurrence was noted in 5 patients who had undergone surgery in the supine position, and in one case in the sitting position. Our results revealed a lower reoccurrence rate in patients undergoing surgery in the sitting position, although not reaching statistical significance [odds ratio (OR): 0.18, 95% confidence interval: 0.01?1.42, p = 0.172]. Conclusion. Craniostomy in the sitting position under local anesthesia is a safe, simple, and reliable procedure for CSDH treatment. Besides being very comfortable for the patient, according to our initial results, it might also lead to a lower reoccurrence rate, probably due to the better management of the air inflow, and consequent pneumocephalus.