Risk Factors For Early Development Research Articles

The clinical, molecular, and therapeutic implications of time from primary diagnosis to brain metastasis in lung and breast cancer patients

AbstractPurposeLung cancer (LC) and breast cancer (BC) are the most common causes of brain metastases (BMs). Time from primary diagnosis to BM (TPDBM) refers to the time interval between initial LC or BC diagnosis and development of BM. This research aims to identify clinical, molecular, and therapeutic risk factors associated with shorter TPDBM.MethodsWe retrospectively reviewed all diagnosed LC and BC patients with BM at Harbin Medical University Cancer Hospital from 2016 to 2020. A total of 570 patients with LC brain metastasis (LCBM) and 173 patients with breast cancer brain metastasis (BCBM) patients who met the inclusion criteria were enrolled for further analysis. BM free survival time curves were generated using Kaplan–Meier analyses. Univariate and multivariate Cox regression analyses were applied to identify risk factors associated with earlier development of BM in LC and BC, respectively.ResultsThe median TPDBM was 5.3 months in LC and 44.4 months in BC. In multivariate analysis, clinical stage IV and M1 stage were independent risk factors for early development of LCBM. LC patients who received chemotherapy, targeted therapy, pulmonary radiotherapy, and pulmonary surgery had longer TPDBM. For BC patients, age ≥ 50 years, Ki67 ≥ 0.3, HER2 positive or triple‐negative breast cancer subtype, advanced N stage, and no mastectomy were correlated with shorter TPDBM.ConclusionsThis single‐institutional study helps identify patients who have a high risk of developing BM early. For these patients, early detection and intervention could have clinical benefits.

Factors Associated with Early Child Development: A Pre-Screening Study

Factors Associated with Early Child Development: A Pre-Screening Study

The Left Ventricular Pressure-Volume Area and Stroke Work in Porcine Model of Ascending Compared to Descending Thoracic Aorta Stenosis Creating a Chronic Early Vs. Late Left Ventricular Afterload Increase.

Objective: Left ventricular hypertrophy in aortic stenosis, arterial hypertension or coarctation of the aorta is risk factor for early development of HF. In chronic late compared to early left ventricular afterload increases resulting from descending thoracic оr ascending aorta stenosis, we assess the left ventricular stroke work, pressure-volume area for О2 demand and effective work on the 4th and 8th weeks. It is suggested that reduced proximal thoracic aortic compliance presents with myocardial ischemia. However, development of adverse left ventricular hypertrophic remodeling and HF in different peak of LV afterload increase is understood poorly. Methods: Fourteen domestic male pigs (28 ± 3 kg) underwent descending thoracic or ascending aortic stenosis through posterior lateral thoracotomy, with cMRI and an invasive left ventricular pressure-volume loops' аrea assessment (Millar 5Fr pig-tailed conductance catheter) on the 4th and 8th weeks. Left ventricular stroke work and pressure-volume area PVA, parameter for LV O2 demand, were assessed in hypertrophic left ventricular remodeling, resulting from different peaks in LV afterload (late vs. early LV afterload) increase and we thus defined early adverse LV hypertrophic remodeling in linear and nonlinear end-systolic pressure-volume regression analysis. For this we used special software. Data was compared with two-way repeated measures ANOVA. Results presented are means ± (SEM) or medians and significance is set at p < 0.05. Results: The left ventricular nonlinear PVA was not different, in LL compared to EL on the 8th week and when using the linear regression analysis. Stroke work was not different. The linear and nonlinear potential energy were not different between LL vs. the EL group. Nonlinear bLVO2 demand was not different, being higher in LL compared to EL in the 8th week. Indexed PVA parameters were not different or changed between the 4th and 8th weeks, when being normalized for body surface-area (m²) or 100 grams of LV mass. Conclusion: The left ventricular potential energy, PVA with effective work and LVO2 demands are not different in hypertrophic LV remodeling in LL vs. EL group at the 8th week. Difference is not present when end-systolic pressure-volume relation is assessed from indexed LV volumes for m² BSA or 100 grams of LV mass. EL is as important as LL in increased LV afterloads based on LV work and mechanical coupling in this hypertensive heart failure model having preserved EF.

Is it good to be bad? An evolutionary analysis of the adaptive potential of psychopathic traits.

Although psychopathy is widely conceptualised as a mental disorder, some researchers question the maladaptive nature of psychopathy, and argue that it might be advantageous from an evolutionary point of view. According to this view, psychopathy can be seen as an evolutionary adaptative strategy that relies on deception and manipulation to gain short-term reproductive benefits. Psychopathy is also identified as a fast life strategy in response to early life stress and an adaptation to harsh environments. This paper investigates the evidence that psychopathic traits are adaptive, while also addressing the limitations of current evolutionary models of psychopathy based on frequency-dependent selection and life history theory. We review recent studies on the fitness correlates of psychopathy and find that psychopathic traits present potential adaptive trade-offs between fertility and mortality, and offspring quantity and quality. On a proximate level, individual differences in stress reactivity and environmental risk factors in early development predispose to psychopathy through gene-environment interactions. We propose that environmental, developmental, social and cultural factors can mediate the relationship between psychopathic traits and fitness and therefore should be considered to make accurate predictions on the adaptive potential of psychopathy. We end by outlining gaps in the literature and making recommendations for future evolutionary research on psychopathy.

Long-term results of hip arthroplasty and determination of unfavorable risk factors for early development of osteonecrosis in patients with systemic lupus erythematosus

Aim of the study – to determine the risk factors for the early development of osteonecrosis and to analyze the results of surgical treatment of patients with systemic lupus erythematosus in the long term after total hip arthroplasty.Materials and methods. The study group included 42 patients with systemic lupus erythematosus (SLE) complicated by osteonecrosis (ON) of the femoral head, who underwent 59 total hip arthroplasty (THA) operations. Before surgery and 6–21 years after THA, in order to assess the long-term results of surgical treatment of patients, the following was assessed: activity of the underlying disease – according to the SLEDAI-2K (Systemic Lupus Erythematosus Disease Activity Index 2000); the severity of irreversible changes in internal organs – according to the SLICC/ACR index of damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology); the clinical and functional state of the hip joint – according to the HHS (Harris Hip Score); the intensity of pain syndrome – according to the visual analogue scale (VAS); quality of life (QOL) – using the SF-36 questionnaire. The concentration of antibodies to cardiolipin (aCL) of IgM and IgG isotypes was determined by enzyme-linked immunosorbent assay (normal range – 0.0–10.0 GPL for IgM, 0–7 MPL for IgG).Results. After 6–21 years of follow-up after THA, there was a statistically significant decrease in pain intensity according to VAS, improvement according to the HHS from 40.0±14.9 to 83.3±17.4 points, SLE activity according to the SLEDAI-2K from 0 to 20 points (median – 4 [4; 8] points) before surgery and from 0 to 41 points (median – 0 [0; 4] points) after a long period of observation. There was a pronounced statistically significant positive dynamics for all QOL indicators studied (p≤0.005 in all cases). The most significant changes were found on the scales RE (Role-Emotional), RP (Role-Physical Functioning) and BP (Bodily Pain). The early development of ON was associated with the degree of activity of the underlying disease, the cumulative dose of glucocorticoids, kidney damage and arthritis in the first year from the onset of SLE, as well as hematological disorders and the presence of aCL in the blood serum 3 years before the onset of ON. The total number of complications was 10.2%.Conclusion. Total hip arthroplasty in patients with systemic lupus erythematosus can achieve a statistically significant reduction in pain intensity, increase functional activity and improve their quality of life.

Correlation between psychological component of school adaptation and socioeconomic risk factors of early development

The subject of this article is the examination of the root problems of the adverse impact of socioeconomic risk factors upon the psychological component of school adaptation of first-graders. The goal lies in establishment of correlation between the characteristics of psychological component of school adaptation of elementary school students and various socioeconomic risk factors in their early development. The research involves 284 first-graders 7-8 years of age (126 girls and 158 boys). Research methodology relies on the following materials: &amp;ldquo;House &amp;ndash; Tree &amp;ndash; Man&amp;rdquo; by J. Buck, &amp;ldquo;Little Houses&amp;rdquo; by A. O. Orekhova, &amp;ldquo;Faces&amp;rdquo; by N. V. Lukyanchenko, T. L. Yadryshnikov, &amp;ldquo;Ladder&amp;rdquo; by V. G. Shchur, social passport of a family. The correlation analysis reveals that the indicators of the psychological component of school adaptation, such as the level of self-esteem, emotional adaptation, depressive states, emotional background, and sense of security, are most affected by the socioeconomic risk factors of early development. The author also establishes the dependence of the characteristics of psychological component of school adaptation of first-graders on the educational background of their parents and family atmosphere. Socioeconomic risk factors in child&amp;rsquo;s life prior to school are rather related to emotional state of a child, determining the emotional well-being and success in school adaptation. Timely identification of these factors allows preventing the difficulties that may arise during the school period.

OBESITY AND ELEVATED LEVELS OF VON WILLEBRAND FACTOR IN PATIENTS WITH HYPERTENSION AND EARLY CORONARY ATHEROSCLEROSIS

Objective: Obesity is one of the additional risk factors for early development of atherosclerosis and cardiovascular complications in patients with hypertension. Von Willebrand factor (vWF) is a plasma glycoprotein which plays an important role in the thrombogenesis. On the other hand it is considered as a marker of the endothelial dysfunction. The objective of our study was to assess the level of vWF in patients with hypertension and early manifestations of coronary atherosclerosis depending on the presence of obesity. Design and method: 79 middle-age (49,88 ± 7,77) patients with hypertension and established coronary atherosclerosis (71 men and 8 women) were involved into study. According to the calculating body mass index (BMI), all subjects were divided into 2 groups: 22 obese people (BMI above 30 kg/m2) and 57 non-obese patients. In all patients we analyzed family history, smoking status, history of diabetes. The plasma lipid profile and vWF level were estimated using EIA kit (Uscn Life Science Inc., Cloud-Clone Corp., USA). Results: Both groups did not differ in the family history of cardiovascular disease, smoking status and diabetes. Though all patients received statins triglycerides levels were significantly higher in obese patients [95%CI: 1.50; 2.57] compared with patients in the other group [95% CI: 1.29; 1.70] (p &lt; 0.05). Almost all but one obese patient had high levels of vWF [95% CI: 53.87; 72.38]. Among patients with a BMI below 30 kg/m2, normal values of vWF were detected in 21 patients [95% CI: 41.38; 52.76]. The groups significantly differed in the level of vWF, both when calculating the odds ratio (OR) using the Pearson chi-square criterion [OR: 5,6; p = 0.0035] and when comparing samples according to the Student's t-criterion (p &lt; 0.005). Conclusions: Results of the study suggest enhanced endothelial dysfunction as one of the possible links between obesity and increased risk of cardiovascular complications in patients with hypertension.

Risk factors for early development of cardiac allograft vasculopathy by intravascular ultrasound.

Cardiac allograft vasculopathy (CAV) is the leading cause of late graft loss. While there are numerous post-transplant factors which may increase the risk of the development of CAV, there is a paucity of data on the impact of donor-derived atherosclerosis (DA), early discontinuation of prednisone, and early initiation of proliferation signal inhibitors (PSI) as assessed by intravascular ultrasound (IVUS). Retrospective single-center study of all adult transplant patients (2008-2017) with serial IVUS at baseline and annually for 5years. DA was defined as a baseline maximal intimal thickness (MIT) ≥0.5mm, and CAV development was defined as MIT ≥1mm or an increase in MIT ≥0.5mm at year 1 compared with baseline or an increase in 0.3mm annually thereafter. Clinical risk factors for CAV were identified using multivariable hazard regression. Separate multistate models were applied to assess the association of prednisone discontinuation and PSI initiation and CAV. Of 282 patients screened, 186 patients had a 1-year angiogram. The mean age of those included in the cohort was 51±11years, 70% were male, 58% were Caucasian, and 27% were supported by a left ventricular assist device. Donor atherosclerosis was present in 40%. The cumulative incidence of CAV at 5years is 41% in DA- vs. 59% in DA + (p=.012). Donor age was a strong predictor of DA (p=.016). Significant risk factors for CAV included male sex (HR=4.141, p=.001), non-Caucasian race (HR=1.98, p=.011), BMI<18kg/m2 (HR=4.596, p=.042), longer ischemic time (HR=1.374, p=.028), older donor age (HR=1.158, p=.009), and rejection with hemodynamic compromise within the first year (HR=2.858, p=.043). Prednisone discontinuation within 1year was associated with a lower risk of CAV (HR 0.58 p=.047). Initiation of proliferation signal inhibitors (PSI) within 2years resulted in fewer cases of CAV (HR 0.397 p<.001). In patients with an angiogram at 1year, those with DA were significantly more likely to develop CAV. Lower incidence of CAV by IVUS was seen in patients who discontinued prednisone in the first year or had initiation of a PSI within two years of transplantation. Knowledge of early IVUS may allow a more tailored approach to patient management.

Biomedical Risk Factors in Early Development and Speech Function Characteristics of First-graders

We studied the speech function parameters in first-graders from the groups of low, moderate and high risk in terms of adverse biomedical factors in early ontogenesis. The study included 1162 first-graders living in Arkhangelsk. A comparative analysis showed that the number of biomedical risk factors in early development correlates positively with the risk of impaired speech development and verbal thinking. In the low-risk group, the speech development parameters were within normal range; in the high-risk group, the parameter values of both speech development and verbal thinking were low. The construction of regression models in the examined sample of children suggests that the most significant risk factor closely related to speech development is “prematurity.” The parameters such as “maternal occupational hazards” and “maternal exposure to medications during pregnancy” also make a significant contribution.

Monoamine oxidase B rs1799836 G allele polymorphism is a risk factor for early development of levodopa-induced dyskinesia in Parkinson's disease.

BackgroundDopamine replacement therapy is an established treatment for motor symptoms of Parkinson's disease, but its long-term use is often limited by the eventual development of motor complications, including levodopa-induced dyskinesia. Genetic background, particularly polymorphisms of dopamine metabolism genes, may affect the occurrence of dyskinesia in Parkinson's disease patients.MethodsWe investigated polymorphisms of dopamine metabolism genes, including catechol-O-methyltransferase, monoamine oxidase B, dopamine beta-hydroxylasedopamine, dopamine receptors D1, D2, and D3, and dopamine transporter, in 110 patients with Parkinson's disease. Cox proportional hazards regression was used to detect associations between genotypes and levodopa-induced dyskinesia.ResultsMonoamine oxidase B rs1799836 was the only polymorphism correlated with risk of dyskinesia. Patients with an AG or GG genotype were more likely to have dyskinesia than those with an AA genotype (adjusted hazard ratio, 3.41; 95% confidence interval, 1.28–9.10). Also, Kaplan-Meier curves demonstrated that patients with an AG or GG genotype developed dyskinesia earlier than those with an AA genotype (log-rank test, p = .004).ConclusionsIn Parkinson's disease patients, the monoamine oxidase B rs1799836 G allele is associated with a greater likelihood of developing dyskinesia than the A allele, possibly due to its association with lower monoamine oxidase B activity in the brain. Thus, detection of monoamine oxidase B polymorphisms may be useful for determining the optimal dosing of antiparkinson medications.

P895 Relationship between left ventricular function components and cardiovascular risk factors in asymptomatic individuals

Abstract Funding Acknowledgements none Background and Aim Coronary artery disease is commonly related to conventional cardiovascular (CV) risk factors. The exact role of those risk factors in early development of CV disease or left ventricular (LV) dysfunction before the development of sign and symptoms remains debated. We studied the relationship between conventional risk factors and LV systolic, diastolic and synchronous function in a population sample of asymptomatic individuals. Methods All participants underwent a detailed echocardiographic examination as part of a cross-sectional survey for the prevalence of coronary risk factors in randomly selected individuals from general population. LV end-systolic and end-diastolic dimensions, and LV volumes and ejection fraction (EF) were all calculated. From the spectral Doppler flow, LV early diastolic (E wave) and atrial systolic (A wave) velocities were measured and E/A ratio calculated. LV filling time (FT) was also measured from the onset of E wave to the end of A wave, and LV ejection time (ET) from the onset to the end of aortic Doppler velocity. Global LV dyssynchrony was assessed using total isovolumic time (T-IVT) as 60 – (total filling time + total ejection time), and Tei index was also calculated. Results The study population comprised 184 individuals (96 male and 88 female, mean age 55.9 (11.3), range 25-78 years). There was no relationship between systolic LV function expressed by EF and CV risk factors. Markers of diastolic function: LV filling velocities and E/A ratio, were correlated with age (r= -0.36, p &amp;lt; 0.000, r= -0.57, p &amp;lt; 0.000, respectively), with glycemia (r= -0.21, p &amp;lt; 0.000, r= -0.14, p = 0.004,) and with systolic blood pressure (r= -0.31, p &amp;lt; 0.000, r= -0.34, p &amp;lt; 0.000). Markers of LV dyssynchrony, in the form of prolonged T-IVT, and raised Tei index, directly correlated with age, glycemia and systolic blood pressure (r = 0.58, p &amp;lt; 0.000, r = 0.18, p &amp;lt; 0.000, r = 0.33, p &amp;lt; 0.000, respectively). However, when these correlations were adjusted for age in a multivariate analysis, the statistical significance was strongly reduced (LV filling) or completely lost (IVT and E/A). Conclusions In normal asymptomatic population, age, rather than CV risk factors, is the main determinant of changes in diastolic and synchronous function.

Presenile cataract and its risk factors: A case control study.

Purpose:Early onset opacification of the lens (cataract) has been observed to be on the rise globally. This study was conducted to determine the various types of presenile cataract and to determine the probable risk factors associated with the occurrence of presenile cataract.Materials and Methods:Patients in the age group of 18–40 years attending the Out-Patient Clinic of the Ophthalmology Department who were found to have presenile cataract were recruited as cases. An equal number of consecutive patients of the same age group were included in the control group. Those who gave consent to participate in the study were interviewed through a preformed questionnaire and underwent a complete ocular examination and set of blood investigations. The type of cataract was noted, data obtained were compiled, and examination and investigations done were documented and analyzed using frequency distribution and Chi-squared test.Results:In total, 90 cases and 90 controls that fulfilled the inclusion criteria were recruited. Most common type of cataract was found to be posterior subcapsular cataract. Presenile cataract was observed to be significantly associated with tobacco intake (P = 0.035), hypercholesterolemia (P = 0.002), fuel exposure (P = 0.004), and lower socioeconomic status (P = <0.001).Conclusions:Tobacco chewing, hypercholesterolemia, and excessive fuel exposure are risk factors for early development of cataract.

Effects of Different Antihypertensive Drug Combinations on Blood Pressure and Arterial Stiffness.

Introduction:Hypertension is significantly contributing to global mortality and morbidity and has been identified as the most important modifiable risk factor for early development of cardiovascular diseases (CVD).Aim:The aim of this study was to investigate the efficacy of different combinations of antihypertensive therapy on blood pressure, arterial stiffness and peripheral resistance in patients with essential hypertension using the brachial oscillometric ambulatory blood pressure monitor.Methods:This study was designed as an observational, prospective, multi centric study conducted in eight primary care centers of the Health Center of Canton Sarajevo during the period of six months. The study included 655 participants, both genders, aged between 30 and 75, who were diagnosed with hypertension according to the ESC/ESH guidelines. Participants were divided into six treatment groups based on the hypertensive drug therapy they were using; lisinopril, losartan or valsartan alone or in combination with hydrochlorothiazide (A, B and C group respectively) or combination of lisinopril, losartan or valsartan with/without hydrochlorothiazide together with amlodipine (D, E and F respectively). The participants were monitored at baseline, after 3 and 6 months (1st and 2nd follow-up). Brachial oscillometric ambulatory blood pressure monitor was used for measuring systolic (SBP), diastolic (DBP), pulse pressure (PP), pulse wave velocity (PWV) and peripheral resistance (PR).Results:SBP, DPB, PP, and PWV significantly decreased from baseline to 2nd follow-up in all treatment groups. The mean reductions in SBP were from -11.7 (95%CI; 9.3- 14.1) to -23.2 (95%CI; 18.3-28.1) mmHg and DBP reductions varied from -5.5 (95%CI; 3.9- 7.1) to -13.4 (95%CI; 7.7-19.1) mmHg. PWV decreased in all treatment groups (from -3.3% to -8.2%). Treatment regiment was not associated with significant differences in SBP, DBP, PP or PWV reductions or their values measured at 2nd follow-up. Peripheral resistance significantly decreased only in group C (p=0.011), group D (p=0.009) and group F (p=0.027).Conclusion:These data suggest that lisinopril/lisinopril + hydrochlorothiazide, losartan/losartan + hydrochlorothiazide and valsartan/valsartan + hydrochlorothiazide alone or in combination with amlodipine are equally effective and well tolerated for the reduction of both systolic and diastolic blood pressure and improve arterial stiffness in patients with essential hypertension.

The association between life satisfaction, vitality, self-rated health, and risk of cancer.

Only few prospective studies have been conducted on the contribution of quality of life-related factors to the risk of cancer. The aim of this study was to investigate the prospective associations of three quality of life-related factors with the risk of cancer; life satisfaction, vitality, and self-rated health. In 2009-2011, 7189 participants in the Copenhagen Aging and Midlife Biobank were asked to rate their life satisfaction, their vitality, and their health. The study population was followed until the end of 2015 for registration of cancer in the Danish National Patient Register. During the follow-up period, cancer was diagnosed in 312 individuals. Life satisfaction was not associated with the risk of cancer. Vitality was significantly associated with the risk of cancer, but the association became non-significant after adjustment for age, sex, socioeconomic position, and lifestyle factors. However, when additionally adjusting for life satisfaction, individuals who rated their vitality as low had a hazard ratio of 1.46 (95% confidence interval [CI] 1.04-2.07) for the development of cancer. Individuals who rated their health as poor had a hazard ratio of 1.70 (95% CI 1.27-2.26) for the development of cancer, compared with individuals with good, very good, or excellent self-rated health. The association remained significant after adjustment for basic confounders, life satisfaction, and vitality. A better grasp of the significance of quality of life-related factors for the risk of cancer may be of great importance to population-based cancer prevention that aims to target early risk factors for development of cancer across widespread cancer sites.

Taq1a polymorphism (rs1800497) is associated with obesity-related outcomes and dietary intake in a multi-ethnic sample of children.

In adults, the Taq1a polymorphism (rs1800497) near the D2 receptor (DRD2) gene is associated with body mass index and binge eating and is more prevalent among non-Hispanic Blacks (NHB) and Hispanic-Americans (HA) relative to non-Hispanic Whites (NHW). We hypothesize Taq1a polymorphism (rs1800497) risk alleles contribute to paediatric racial/ethnic differences in obesity phenotypes. This study aims to characterize the relationship between the Taq1a polymorphism (rs1800497), diet and adiposity in a multi-ethnic cohort of 286 children (98 NHB, 76 HA and 112 NHW), ages 7-12. Dual-energy X-ray absorptiometry, computed tomography scans and two 24-h dietary recalls assessed body composition, fat distribution and dietary intakes, respectively. Children with two Taq1a risk alleles (NHB=50.0%, HA=43.3%, NHW=6.7%) reported a 20% increase in total energy intake (P=0.0034) and per cent of calories from sugar consumed (P=0.0077) than did children with less than two risk alleles. Children with two Taq1a risk alleles demonstrated significantly higher total body fat (P=0.0145), body fat percentage (P=0.0377), intra-abdominal adiposity (P=0.0459), subcutaneous abdominal adiposity (P=0.0213) and total abdominal adiposity (P=0.0209) than did children with one or no Taq1a risk alleles. Our results suggest that having two Taq1a risk alleles is associated with an increase in reported calorie and sugar consumption and is a potential risk factor for early development of excess adiposity in multi-ethnic children. These results need to be confirmed in a larger sample.

Predicting Diabetes in the First Two Years Postpartum among Women with Recent Gestational Diabetes—The Linda-Brasil Study

Background: GDM is a strong risk factor for early development of diabetes. Yet, adherence to protocols for testing at postpartum is usually low. We investigated the main predictors of diabetes up to two years post-partum among women with recent GDM participating in the LINDA-Brasil cohort. Methods: We recruited potential participants with GDM for an ongoing clinical trial of postpartum diabetes prevention, LINDA-Brasil. We ascertained diabetes by OGTT. We estimated relative risks and 95% CIs, and area under the ROC curve (AUC) for diabetes postpartum through logistic regression. Results: We recruited 27women with GDM, of whom 1482 (55%) underwent OGTT testing postpartum. Among these, mean (SD) pre-pregnancy BMI was 30.2 (6.4) kg/m2 and mean age, 32.0 (6.3) years; 316 (21.3%) used insulin during pregnancy, an additional 314 (21.2%) oral hypoglycemic agents (OHAs). During follow-up, 163 (11%) developed diabetes. Use of insulin during pregnancy predicted a six-fold higher crude risk of developing diabetes postpartum (RR 6.7; 95% CI 4.7-9.4) and of OHAs, a two-fold risk (RR=2.0; 95% CI 1.4-2.9). The inclusion of just these two variables yielded an AUC of 0.754; adding fasting and 2h plasma glucose at the diagnosis of GDM increased it to 0.810; further addition of age and pre-pregnancy BMI increased it minimally (0.813), and age was not statistically significant. Most incident cases used insulin (59%) or OHAs alone (20%) during pregnancy, thus, 79% of all cases (sensitivity) could be identified as being at high risk just by this information. Stated as post-test probabilties, 20% of those using antidiabetic medication during pregnancy but only 4% of those not using medication developed diabetes. Conclusions: Simple clinical or administrative information can be effectively used to prioritize screening and counselling for diabetes prevention in the initial years following pregnancy complicated by GDM. Disclosure C.D. Castilhos: None. R. Ladwig: None. M. Drehmer: None. B.B. Duncan: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company. C. Facanha: None. M.I. Schmidt: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company.

CARDIOMETABOLIC RISK FACTORS IN CHILDREN WITH SYSTEMIC LUPUS ERYTHEMATOSUS, LUPUS NEPHRITIS

This article provides an assessment of risk factors for early development of cardiovascular and metabolic disorders in children with systemic lupus erythematosus (SLE), lupus nephritis (LN). The contribution to the development of early disturbances of immune inflammation, metabolic imbalance, arterial hypertension, left ventricular hypertrophy, carotid intima-media thickness showed.

Antihyperlipidemic, Antiatherosclerotic and Cardio-protective Activity of Leaves and Aerial Roots of Heritiera fomes (Sundari) Extract on Alloxan-induced Diabetic Sprague Dawley Rats

Background: Hyperlipidemia is one of the leading causes of death in developed as well as in developing countries like Bangladesh. Hyperlipidemia is a major risk factor for early development of atherosclerosis and its cardiovascular complications. The objective of the study was to evaluate antihyperlipidemic, antiathersclerotic and cardio-protective activities of the leaves (LE) and aerial root (AR) extracts of Heritiera fomes (Family: Malvaceae, local name: Sundari) which is a common species in the world’s largest mangrove forest, Sundarbans, major part of which is located in Bangladesh. Methods and findings: Extracts of the powdered LE and AR of Heritiera fomes were obtained using methanol, and the extracts were applied at doses of 250 and 500 mg/kg of body weight, to treat the diabetic rats. Alloxan Monohydrate was used to induce diabetic condition in Sprague dawley rats. Metformin Hydrochloride was also used as a standard drug to treat the diabetic rats in order to compare the efficacy of the plant extracts with that of the standard drug. After 21 days of treatment, the animals were sacrificed and lipid profiles were estimated. The lipid levels were elevated in alloxan-induced diabetic rats as compared to the control rats. Total cholesterol, triglycerides, LDL and VLDL were increased in diabetic rats and the HDL level was significantly (P<0.001) decreased. After treatment with Heritiera fomes (LE and AR), the lipid levels of diabetic rats were returned to normal level and this reduction was dose-dependent, whereas HDL level was significantly (P<0.001) increased. LE and AR extracts also reduced atherosclerotic index and increased cardio-protective index as compared to the diabetic rats. Conclusion: Conventional drugs available for the treatment of hyperlipidemia carry the risks that may lead to many adverse effects such as weight loss, hypoglycemia, muscle pain, muscle damage, liver damage etc. So, medicinal plants having antihyperlipidemic, antiathersclerotic and cardio-protective properties should be given importance to avoid the adverse effects associated with modern allopathic lipid-lowering drugs. This study demonstrated that Heritiera fomes can be an excellent medicinal plant for the treatment of hyperlipidaemia, atherosclerosis and cardiovascular complications.

Risk factors for early metachronous tumor development after endoscopic resection for early gastric cancer.

BackgroundMetachronous gastric tumor (MGT) is one of major concerns after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Optimal follow-up strategy has not been yet well-established. The aim of this study was to identify the different clinical features of the patients according to the time interval to development of MGT.MethodsAmong 1,780 consecutive patients with EGC who underwent ESD between 2005 and 2014, 115 patients with MGT were retrospectively reviewed. MGT was defined as secondary gastric cancer or dysplasia detected > 1 year after initial ESD. Clinicopathological factors associated with early development of MGT were evaluated.ResultsThe median interval to development of MGT was 37 months. In univariate analysis, the median interval to MGT was shorter if EGC lesion was non-elevated type (39.4 vs 57.0 months, p = 0.011), or synchronous primary lesion was absent (39.8 vs 51.4 months, p = 0.050). In multivariate Cox’s proportional hazards analysis, the hazard ratios for early occurrence of MGT were 1.966 (95% CI: 1.141–3.386, p = 0.015) and 1.911 (95% CI: 1.163–3.141, p = 0.011), respectively. There was no significant difference in overall survival after diagnosis of MGT between the early occurrence group and the late occurrence group.ConclusionsNon-elevated gross type and absence of synchronous gastric tumor were independent risk factors for early development of MGT. Meticulous endoscopic inspection is especially important for the detection of MGT during the early follow-up period in patients with these initial tumor characteristics.

The Prevalence of Radiographic Criteria of Femoral Acetabular Impingement in Patients Undergoing Hip Arthroplasty Surgery

Pistol grip deformity of the proximal femur has been reported as a potential cause of hip pain and early-onset arthritis. The exact incidence of patients with osteoarthritis resulting from femoral acetabular impingement (FAI) is unknown. The purpose of this study was to explore the relationship between radiographic markers of FAI in patients undergoing hip arthroplasty. We retrospectively reviewed the radiographs of patients undergoing hip arthroplasty by a single surgeon over a 2-year period. The patients were divided by age, those younger than 65 years and (group A) and those 65 years and older (group B). The radiographs were evaluated for morphology consistent with FAI including an α angle >55°, crossover sign, coxa profunda, acetabular protrusio, and ischial spine sign. Three independent reviewers evaluated all the radiographs. The incidence of CAM, Pincer, and mixed deformities were compared between the 2 groups. A total of 255 patients with 258 hip arthroplasties were included in this analysis. Group A was found to have a greater number of patients with CAM morphology. Linear regression analysis revealed that the α angle was greater in younger patients. Patients undergoing hip arthroplasty exhibit a high incidence of radiographic abnormalities consistent with FAI. The CAM-type morphology occurs more frequently in younger patients with advanced arthritis requiring hip arthroplasty. This morphology is thought to cause a delaminating injury to the cartilage of the acetabulum. This study supports the notion that CAM-type morphology is a risk factor for early development of degenerative arthritis of the hip.