Risk Factor For Worsening Research Articles

Women’s Cardiac Health in 2020: A Systematic Review

AbstractAlthough substantial progress has been made toward improving gender- and sex-specific cardiovascular disease (CVD) management and outcomes, contemporary reports indicate a persistent knowledge gap with regard to optimal risk-stratification and management in female cardiac heart disease (CHD) patients. Prominent patient and system delays in diagnosing CHD are, in part, due to the limited awareness for the latent CVD risk in women, a lack of sex-specific thresholds within clinical guidelines, and subsequent limited performance of contemporary diagnostic approaches in women. Several traditional risk factors for CHD affect both women and men. But other factors can play a bigger role in the development of heart disease in women. In addition, little is known about the influence of socioenvironmental and contextual factors on gender-specific disease manifestation and outcomes. It is imperative that we understand the mechanisms that contribute to worsening risk factors profiles in young women to reduce future atherosclerotic CVD morbidity and mortality. This comprehensive review focuses on the novel aspects of cardiovascular health in women and sex differences as they relate to clinical practice and prevention, diagnosis, and treatment of CVD. Increased recognition of the prevalence of traditional cardiovascular risk factors and their differential impact in women, as well as emerging nontraditional risk factors unique to or more common in women, contribute to new understanding mechanisms, leading to worsening outcome for women.

S3127 Colonic Polyp Surveillance Guidelines Are Appropriate for Younger Patients Despite Having Higher Grade Polyps on Surveillance Colonoscopy Compared With Older Patients

INTRODUCTION: Over the past few decades, the incidence of colorectal cancer (CRC) in the United States has been decreasing for older patients (OP, ≥50 years old), but increasing for younger patients (YP, < 50 years old). Current colonic polyp surveillance guidelines are primarily based on data from OP and may not be appropriate to use in YP given the reported increase in rates of CRC in YP. Our aim was to investigate whether existing colonic polyp surveillance guidelines created for OP are appropriate for use in YP. METHODS: We performed a retrospective cohort study of patients from two academic medical centers. We generated Risk Stratification Groups (RSG) based on surveillance colonoscopy intervals recommended by the USMSTF for CRC (Table 1). To determine if current colonic polyp surveillance guidelines were appropriate, we measured whether a patient's RSG worsened from index to surveillance colonoscopy, signifying that higher grade polyps were found on the subsequent surveillance colonoscopy compared to the index colonoscopy. Changes in RSG between OP and YP was determined using a McNeamer Test. A multivariate analysis was used to determine independent risk factors for RSG worsening. RESULTS: 1892 patients were included in the study, comprising 1521 OP and 371 YP. At both index and surveillance colonoscopies, YP were more likely to be assigned to a lower RSG (lower grade polyps) compared with OP. However, a greater percentage of YP had their RSG worsen from index to surveillance colonoscopy compared with OP (32.34% vs 25.18%, P < 0.01) (Figure 1). YP were 1.63 times more likely to have RSG worsening compared with OP (95% CI = 1.2–2.2) after controlling for confounding factorsTable 1.: Risk Stratification of Patients Based on Surveillance Colonoscopy Time Recommendations from the US Multi-Society Task Force on Colorectal CancerFigure 1.: Risk Stratification Group (RSG) Changes Between Index and Surveillance Colonoscopies for Older Patients and Younger Patients.Figure 2.: Tier to Tier Risk Stratification Group (RSG) Changes Between Index and Surveillance Colonoscopies for Older Patients and Younger Patients.Most of the RSG worsening was from RSG 1 (normal colonoscopy or small hyperplastic polyps) to RSG 2 (1–2 small tubular adenomas) for both YP and OP (21.02% & 15.06%, respectively) (Figure 2). There were no cases of CRC found in YP and 5 cases of CRC diagnosed in OP on surveillance colonoscopy. CONCLUSION: In our cohort, RSG worsening between index and surveillance colonoscopy was more prevalent in YP compared with OP. Yet, most of the RSG worsening was not clinically meaningful in terms of progression to CRC. This would imply that for the sake of CRC prevention, current surveillance guidelines were indeed appropriate for YP in our cohort of patients. Further study is needed to determine why RSG worsening was higher in YP compared with OP and whether there is any clinical or practical significance to this RSG worsening.

Active implications for dermatologists in 'SARS-CoV-2 ERA': Personal experience and review of literature.

Linked articles: COVID‐19 SPECIAL FORUM. J Eur Acad Dermatol Venereol 2020; 34: e346–e380.

Clinical and Imaging Factors Associated With the Outcomes of Tubercular Serpiginous-like Choroiditis

To analyze baseline clinical and imaging risk factors associated with poor outcome in patients with tubercular serpiginous-like choroiditis (TB SLC). Retrospective clinical study. Charts and fundus photographs of consecutive patients with active TB SLC seen at a single tertiary referral center with 6months follow-up after initiation of treatment were reviewed. Logistic mixed models were performed to determine the clinical and imaging factors associated with the response to therapy, including the opacity of choroiditis graded according to a 3-point scale. This study included 203 eyes of 183 patients with active TB SLC. Poor initial best-corrected visual acuity (BCVA) and foveal and optic disc involvement were associated with poor response to therapy at 6months (odds ratio [OR] 4.489, 95% confidence interval [CI]: 1.92-10.47; P = .001; OR 2.892, 95% CI: 1.23-6.81; P= .015; OR 11.633, 95% CI: 3.17-42.71; P < .001, respectively). The high opacity grades (2 and 3) were also associated with poor outcomes OR 9.541; 95% CI: 2.94-30.91; P= .001). Poor baseline BCVA and high grade of opacity of the lesions were the composite risk factors for paradoxical worsening of TB SLC (OR 7.555, 95% CI: 1.78-32.02; P= 0.006; OR 7.434, 95% CI: 1.34-41.18; P =0.021, respectively). TB SLC with higher grades of lesion opacity at baseline may be associated with greater risk of poor therapeutic response and paradoxical worsening. Grading of baseline lesion opacity may be used in future prospective studies to predict the biological behavior of the lesions and may serve as a guide to therapeutic interventions.

Epilepsy Care in the Time of COVID-19 Pandemic in Italy: Risk Factors for Seizure Worsening.

Objective: In early 2020, Italy struggled with an unprecedented health emergency related to the COVID-19 pandemic. Medical care of chronic neurological diseases, such as epilepsy, is being sorely neglected. In this national survey, we aimed at understanding the impact of COVID-19 lockdown on the care of people with epilepsy (PwE) and identifying PwE risk factors for seizure worsening to direct telemedicine efforts.Methods: We administered a 48-items online survey (published on April 11, 2020) including socio-demographic, epilepsy-related, and psychometric variables (BDI-II for depression, GAD-7 for anxiety, and PSQI for sleep) to PwE and people without epilepsy (PwoE). Regression analysis identified predictors of seizure worsening.Results: We collected responses from 456 PwE (344 females) and 472 PwoE (347 females). Outpatient examinations of PwE were postponed in 95% of cases. One-third of PwE complained of issues with epilepsy management, but only 71% of them reached the treating physician and solved their problems. PwE had worse depressive and anxiety symptoms (higher BDI-II and GAD-7 scores; p < 0.001) than PwoE. Sleep quality was equally compromised in both groups (47 and 42%). Sixty-seven PwE (18%) reported seizure worsening, which was best explained by the number of anti-seizure medications (ASM) of chronic therapy and the severity of sleep disorder.Conclusions: During the current COVID-19 pandemic, a significant percentage of PwE experienced difficulties in follow-up and a seizure number increase, in particular those chronically taking more ASMs and with poor sleep quality. This dramatic experience outlines the urgent need for validation and implementation of telemedicine services for epileptic patients in order to provide regular follow-up.

Patellar Malalignment Is Associated With Patellofemoral Lesions and Cartilage Relaxation Times After Hamstring Autograft Anterior Cruciate Ligament Reconstruction

Background: There is growing evidence suggesting a link between patellofemoral joint (PFJ) osteoarthritis in anterior cruciate ligament (ACL)–reconstructed knees and altered joint alignment. Purpose: To determine whether patellar alignment differs between participants with and without ACL reconstruction (ACLR) and to identify possible associations between patellar alignment and PFJ osteoarthritis features over 3 years. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 37 participants with ACLR (sex, 23 male; mean ± SD age, 28.1 ± 7.4 years) and 20 healthy controls (13 male; 30.4 ± 4.8 years) participated. Patients underwent magnetic resonance imaging: (1) sagittal T2-weighted fat-saturated fast spin echo images to calculate patellar alignment, (2) sagittal 3-dimensional intermediate-weighted fast spin echo Cube sequence for clinical morphological grading (modified Whole-Organ Magnetic Resonance Imaging Score [WORMS]), and (3) sagittal combined T1ρ/T2 mapping sequence for performing voxel-based relaxometry. Patellar alignment of the ACLR knees were assessed at 6 months (baseline). One-way analysis of variance was used to compare patellar alignment among the ACLR (at 6 months), contralateral, and control knees. Within the ACLR group, a logistic regression model was used to identify if patellar alignment measures at baseline were risk factors for worsening of PFJ structural changes over 3 years. Statistical parametric mapping was used to evaluate the longitudinal associations between patellar alignment and cartilage relaxation times at 3 years. Results: When compared with control knees, ACLR knees exhibited a laterally and anteriorly displaced patella (P = .045 and P = .041), less flexion (P = .031), and less lateral spin (P = .012). Furthermore, excessive lateral displacement was a significant predictor of worsening of WORMS (P = .050). Lateral displacement was positively correlated with increased T1ρ and T2 in the patellar and trochlear cartilage at 3 years. Patellar lateral spin revealed similar negative findings. Conclusion: Participants with ACLR exhibited a laterally and anteriorly displaced patella, less flexion, and less lateral spin when compared with healthy controls. Excessive patellar lateral displacement was the strongest predictor to the development of PFJ osteoarthritis features longitudinally.

THU0153 TCZ MIGHT BE A RISK FACTOR FOR WORSENING OF ILD, PARTICULARLY OF CHRONIC ILD

Background:Interstitial lung disease (ILD), frequent lung involvement, determine the prognosis of patients with RA. The presence of ILD also influences the selection of RA therapy. However, it is not fully elucidated what groups of RA-ILD patients worsen ILD.Objectives:To identify the risk factors for worsening of ILD in RA patients under biological DMARD (bDAMARDs) therapy; particularly to determine whether types of bDMARDs are associated with exacerbation of ILD.Methods:A retrospective cohort study was conducted. Subjects were consecutive 91 RA-ILD patients who received HR-CT examination at starting and during bDMARDs therapy. Clinical data were collected by reviewing.ILD was diagnosed, when patients showed ground-glass opacity (GGO), consolidation, reticular pattern or honeycomb; the former two were acute and the latter two were chronic ILD lesions. The extent of each lesion was scored and recorded. When the score was increased, the lesion was judged as worsened. The incidence of exacerbation of ILD under an indicated agent was calculated as follows; the sum of (exposure period of the agent/exposure period of any agent) in patients with the exacerbation was divided by total exposure period of the agent.Results:Subjects were 36 males and 55 females with a mean age of 66.8 years. At the entry, GGO, consolidation, reticular and honeycomb were found in16, 20, 63 and 17, respectively. Acute and chronic ILD were observed in 34 and 68, respectively. ILD worsened in 35 (38.5%). Between patients with and without ILD exacerbation, no differences were found in demographics (sex, age, disease duration, the positivity for anti-CCP ab and RF) and radiographic findings of pulmonary abnormalities. Disease activities at as 1st and sequential CT examinations were similar in both groups.The incidences of the worsening of ILD varied according to bDMARDs (Fig 1). The incidence of total ILD worsening was high in TCZ compared to TNF and ABT. The incidence of acute ILD worsening was similar among the three groups. However, the worsening of chronic ILD was more frequently found in TCZ than other bDMARDs. The incidence of death by respiratory failure was similar in TNF, ABT, and TCZ (Fig. 2).Fig. 1Conclusion:TCZ might be a risk factor for exacerbation of ILD, particularly of chronic ILD.Fig. 2Disclosure of Interests:None declared

The effect of retirement on biomedical and behavioral risk factors for cardiovascular and metabolic disease

Retirement is a major life event potentially associated with changes in relevant risk factors for cardiovascular and metabolic conditions. This study analyzes the effect of retirement on behavioral and biomedical risk factors for chronic disease, together with subjective health parameters using Southern German epidemiological data. We used panel data from the KORA cohort study, consisting of 11,168 observations for individuals 45–80 years old. Outcomes included health behavior (alcohol, smoking, physical activity), biomedical risk factors (body-mass-index (BMI), waist-to-hip ratio (WHR), glycosylated hemoglobin (HbA1c), total cholesterol/HDL quotient, systolic/diastolic blood pressure), and subjective health (SF12 mental and physical scales, self-rated health). We applied a parametric regression discontinuity design based on age thresholds for pension eligibility. Robust results after p-value corrections for multiple testing showed an increase in BMI in early retirees (at the age of 60) [β = 1.11, corrected p-val. < 0.05] and an increase in CHO/HDL in regular retirees (age 65) [β = 0.47, corrected p-val. < 0.05]. Stratified analyses indicate that the increase in BMI might be driven by women and low educated individuals retiring early, despite increasing physical activity. The increase in CHO/HDL might be driven by men retiring regularly, alongside an increase in subjective physical health. Blood pressure also increased, but the effect differs by retirement timing and sex and is not always robust to sensitivity analysis checks. Our study indicates that retirement has an impact on different risk factors for chronic disease, depending on timing, sex and education. Regular male, early female, and low educated retirees should be further investigated as potential high-risk groups for worsening risk factors after retirement. Future research should investigate if and how these results are linked: in fact, especially in the last two groups, the increase in leisure time physical activity might not be enough to compensate for the loss of work-related physical activity, leading thus to an increase in BMI.

How do different chronic condition comorbidities affect changes in depressive symptoms of middle aged and older adults?

BackgroundDifferent types of chronic condition comorbidities can have dissimilar effects on the improvements or deterioration of mental health in older adults. This study aims to examine the impacts of different types of chronic conditions on inter-temporal trends of depressive symptoms. MethodsData on 11,457 adults from age 45 in the China Health and Retirement Longitudinal Study (CHARLS) 2011–2015 were used to estimate the prevalence of comorbidities. We used latent class analysis to identify patterns of how depressive symptoms changed over time, then estimated the odds ratios of worsening or improved levels of depression by types of chronic conditions. ResultsPrevalence of depression differed by types of chronic condition comorbidities. Dyslipidemia, asthma, liver disease, kidney disease, stomach or other digestive disease, and arthritis or rheumatism were significant risk factors for worsening of depressive symptoms over time among people with low levels of depressive symptoms at baseline. Among people with higher levels of depression at baseline, arthritis, stroke, digestive, and memory-related diseases were risk factors for not improving. LimitationsFindings are unlikely to be generalizable to subpopulations with severe levels of physical or mental disabilities as they are unlikely to be captured in the surveys. ConclusionsGiven these specific physical health conditions’ effects on mental health, clinicians can consider patients’ mental health in their repertoire with regards to particular diseases.

Long-Term Outcome After Renal Replacement Therapy in Severe Burns.

Acute kidney injury is a common sequela after major burn injury, but only a small proportion of patients need renal replacement therapy. In the majority of patients, need for renal replacement therapy subsides before discharge from the burn center but limited literature exists on long-term outcomes. A few studies report an increased risk for chronic renal failure after burn injury. We investigated the long-term outcome of severely burned patients receiving renal replacement therapy during acute burn injury treatment. Data on 68 severely burned patients who received renal replacement therapy in Helsinki Burn Centre between November 1988 and December 2015 were collected retrospectively. Thirty-two patients survived and remained for follow-up after the primary hospital stay until December 31, 2016. About 56.3% of discharged patients were alive at the end of follow-up. In 81.3% of discharged patients, need for renal replacement therapy subsided before discharge. Two patients received renal replacement therapy for longer than 3 months; however, need for renal replacement therapy subsided in both patients. One patient required dialysis several years later on after the need for renal replacement therapy had subsided. This study showed that long-term need for renal replacement therapy is rare after severe burn injury. In the vast majority of patients, need for renal replacement therapy subsided before discharge from primary care. Acute kidney injury in association with burns is a potential but small risk factor for later worsening of kidney function in fragile individuals.

Analysis of pelvic compensation for dynamic sagittal imbalance using motion analysis.

To analyze pelvic compensation during walking in patients with severe sagittal plane deformity by using motion analysis. A total of 44 patients with sagittal plane deformity who were scheduled to undergo surgery were included. Motion analysis was performed 3 consecutive times during walking to estimate the anterior pelvic tilt (Ant-PT) angle, trunk kyphosis (TK) angle, and distance of the center of gravity (CoG) from the center of mass (CoM) of the pelvic segment, and hip and knee joint angles during gait. The patients were classified into Ant-PT+/Ant-PT-, TK+/TK-, and CoG+/CoG- groups according to the changes in Ant-PT angle, TK angle, and distance of the CoG from the CoM of the pelvic segment. Increases and decreases in the values of the variables from the first trial to the third trial were indicated with "+" and "-" signs, respectively. The mean Ant-PT angle, TK angle, and distance of the CoG from the CoM of the pelvic segment increased progressively, and the differences in the values of these variables from the first to the third trials were statistically significant (P = 0.046, P = 0.004, and P = 0.007 for the Ant-PT angle, TK angle, and distance of the CoG from the CoM of pelvic segment, respectively). Among the 44 patients, 27 and 34 were classified into the Ant-PT+ and CoG+ groups, respectively. Older age and higher body mass index (BMI) were significantly associated with the Ant-PT+ group. The CoG+ group demonstrated a significantly higher height and weight than the CoG- group. Higher BMI, height, and weight are risk factors for progressive worsening of dynamic sagittal imbalance. These slides can be retrieved under Electronic Supplementary Material.

The Risk Factor of Worsening Low Back Pain in Older Adults Living in a Local Area of Japan: The GAINA Study.

Several factors, particularly osteoporosis, obesity, and a lack of exercise, contribute to low back pain (LBP). This observational longitudinal cohort study to identify the risk factors for worsening low back pain. We sent a self-administered questionnaire and a consent form for this study to 1,450 subjects aged > 40 years in Hino, Japan. Baseline assessments of 273 individuals undergoing medical check-ups were conducted from 2014 to 2016. The subjects were divided into Group A (no change or improvement in LBP) and Group B (worsening LBP). LBP was assessed using a visual analog scale; body mass index (BMI), bone mineral density, skeletal muscle index (SMI), standing posture, and habitual exercise frequency were also evaluated. We defined, habitual exercise as nontherapeutic exercise (e.g. swimming, walking, physical exercise and work out). Overall, 81.2% subjects performed habitual exercise in Group A, a greater number of subjects than the 40.8% in Group B. BMI, SMI, and bone mineral density (BMD) were not significantly different between the two groups. Lack of exercise was a significant risk factor for worsening of LBP. On the other hand, the lack of osteoporosis treatment was significantly different between subjects with worsening LBP despite habitual exercise and those who did not perform habitual exercise. Although habitual exercise is useful to prevent LBP, it may not necessarily be useful for those with a lack of osteoporosis treatment. Although exercise is typically posited to prevent LBP, it may not be effective in preventing LBP associated with osteoporosis.

Does wearing swimming goggles affect corneal morphology in keratoconic eyes?

A significant transient increase in intraocular pressure in individuals wearing swimming goggles has been demonstrated in previous studies. These findings suggested that wearing swimming goggles could represent a significant risk factor for worsening of corneal parameters in patients with keratoconus who swim regularly. The aim of this study was to investigate corneal parameters in patients with keratoconus after wearing swimming goggles. Comprehensive ocular examinations were performed on 74 eyes of 37 patients with keratoconus. Measurements of the corneal front keratometry values (Kflat, Ksteep, and Kmax), central corneal thickness, corneal apex thickness, thinnest corneal thickness, corneal volume, anterior chamber volume, anterior chamber depth, and iridocorneal angle were performed in outpatient clinics using a Pentacam® Scheimpflug camera (Oculus, Wetzlar, Germany) before the patients wore swimming goggles and after they wore swimming goggles for 1, 10, and 20 min. A p-value of <0.05 was regarded as statistically significant. The average values before and after wearing swimming goggles for 1, 10, and 20 min were 52.72 ± 5.36, 52.64 ± 5.52, 52.62 ± 5.38, and 52.22 ± 4.86, respectively (p=0.257). The average values before and after wearing swimming goggles for 1, 10, and 20 min were 46.01 ± 3.17, 46.09 ± 3.17, 46.06 ± 3.26, and 46.04 ± 3.17, respectively (p=0.426). The average values before and after wearing swimming goggles for 1, 10, and 20 min were 49.02 ± 3.56, 49.06 ± 3.61, 49.08 ± 3.62, and 49.07 ± 3.61, respectively (p=0.750). No other corneal parameters showed changes after wearing swimming goggles (p>0.05). However, the anterior chamber volume markedly decreased after wearing swimming goggles (p<0.001). These findings suggested that the short-term use of swimming goggles does not increase the risk of corneal parameter worsening in patients with keratoconus.

Relevance of IgE, allergy and eye rubbing in the pathogenesis and management of Keratoconus.

Keratoconus (KC) is an ectatic disease of the cornea characterized by localized thinning and protrusion causing irregular astigmatism, which can lead to significant visual impairment. KC has often been associated with allergy and/or atopy, which are immune-mediated inflammatory reactions primarily driven by IgE. A higher proportion of KC patients were reported to have history or suffer from systemic and/or ocular allergy with elevated allergen-specific IgE and/or total serum IgE. Eye rubbing, one of the risk factors for worsening of the disease and developing related complications in KC, is associated with IgE driven conditions. The current review enumerates and contextualizes the evidence related to IgE in mediating KC pathogenesis, including aberrant extra-cellular matrix remodeling. This review also discusses clinical strategies directed at modulating IgE-mediated responses in the management of KC, and the emerging academic and plausible clinical relevance of assessing serum and tear IgE (allergen-specific and total) status in improving the understanding of disease pathobiology, treatment planning, and prognosis.

Patient trends and outcomes of surgery for type A acute aortic dissection in Japan: an analysis of more than 10 000 patients from the Japan Cardiovascular Surgery Database.

To evaluate the background trends and surgical outcomes for more than 10000 patients with acute type A dissection in Japan in a recent 8-year period. Data on replacement of the ascending aorta and/or aortic arch for acute type A dissection were collected from the Japan Cardiovascular Surgery Database from 2008 to 2015. Linear-by-linear association tests or Cuzick's test for trend was used to evaluate group trends over time. The results were calculated for ascending or hemiarch replacement and arch replacement. A multivariable logistic regression model was used to calculate the risk-adjusted operative mortality rate. A total of 11843 patients were included. The overall 30-day mortality and operative mortality rates were 7.6% and 9.5%, respectively. The number of surgically treated cases increased from 2436 patients in 2008-2009 to 3533 in 2014-2015, a 45.0% increase. A trend analysis revealed significant changes in patient characteristics with time, including increasing age and rate of preoperative renal failure. Despite worsening risk factors, the unadjusted operative mortality rate with arch replacement showed a significant downward trend (P = 0.01; test of trend). The risk-adjusted mortality rate showed a downward trend both in ascending aorta or hemiarch replacement and arch replacement, although the trend was not statistically significant (P > 0.05). Unadjusted and adjusted operative deaths have shown a decreasing trend, although patients undergoing surgery for acute type A dissection have demonstrated worsening of risk factors, such as age and renal failure. The number of surgeries performed for acute type A dissection significantly increased throughout the study period in Japan.

Role of cell free microRNA-19a and microRNA-19b in gestational diabetes mellitus patients.

Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes in pregnant women and it's prevalence is increasing worldwide. A total 100 cases of GDM and 100 healthy controls were included in a study and blood samples were collected in plain vials from all study participant. Difference among several variables which included BMI, glycemia, insulinaemia, HbA1c, total cholesterol, triglycerides, urinary albumin were compared between GDM cases and controls and were found to be statistically significant (p < 0.0001). Additionally, GDM cases showed 4.0 fold increase in miRNA-19a and 4.7 mean increase in miRNA-19b expression compared to healthy control individuals. A positive correlation was observed between miRNA-19a and miRNA-19b among GDM cases. However the correlation coefficient was 0.13 between miRNA-19a and miRNA-19b. This suggested that with the increase in miRNA-19a, miRNA-19b also increased. The findings of this study concludes that an increase in microRNA-19a and microRNA-19b is observed in GDM cases and could be linked with increased risk factor for worsening of the disease. MicroRNA-19a and 19b have been linked to alcoholism and smoking and could also be the factors in GDM.

IFNL3 genotype is associated with pulmonary fibrosis in patients with systemic sclerosis

Fibrosis across different organs and tissues is likely to share common pathophysiological mechanisms and pathways. Recently, a polymorphism (rs12979860) near the interferon lambda gene (IFNL3) was shown to be associated with fibrosis in liver across multiple disease etiologies. We determined whether this variant is a risk factor for pulmonary fibrosis (PF) and worsening cutaneous fibrosis in systemic sclerosis (SSc). Caucasian patients with SSc (n = 733) were genotyped to test for association with the presence of PF and worsening of skin fibrosis. Serum IFN-λ3 levels from 200 SSc cases were evaluated. An association of the IFNL3 polymorphism with PF was demonstrated (OR: 1.66 (95% CI: 1.142–2.416, p = 0.008). The IFNL3 variant was not a risk factor for worsening of skin fibrosis. Functionally, IFN-λ3 serum levels were higher among subjects with PF compared to those unaffected (P < 0.0001). In conclusion, IFNL3 serum levels and the genetic variant known to be associated with liver fibrosis are similarly linked to PF, but not to worsening of skin fibrosis in SSc. These data highlight both common fibrosis pathways operating between organs, as well as differential effects within the same disease.

Assessment of risk factors for occurrence or worsening of acetabular fracture following percutaneous cementoplasty of acetabulum malignancies

PurposeTo evaluate the clinical, radiological and periprocedural features associated with the occurrence or worsening of acetabular fracture (OWAF) following percutaneous cementoplasty of the acetabulum (PCA) in cancer patients. MethodAll patients who underwent PCA in our comprehensive cancer center for an acetabular metastasis between January 2008 and December 2015 were included. Clinical features, characteristics of the metastasis on computed tomography (CT-scan) (location [roof, quadrilateral surface, anterior and posterior columns], number of locations, matrix, extra/intra-articular fractures, extra-osseous or subchondral extensions) and of the procedure (extra- or intra-articular cement leakage (IACL), percentage of filling of each location, complications) were reported as well as prior, concomitant or post-PCA treatments. The endpoint was OWAF on CT-scan during post-PCA follow-up. Log-rank tests and Cox models were used to identify prognostic factors. Results140 PCA were identified in 129 patients (11 bilateral procedures, median age: 66.6). Eighteen (18/140, 12.9%) had an initial articular fracture. IACL was seen in 12/140 (8.6%) PCA. The only feature associated with IACL was a pre-existing articular fracture (p = 0.009). Of the 111 patients with imaging follow-ups, 18 (16.2%) showed OWAF. In multivariate analysis, the presence of cement filling (even partial) of all acetabular metastatic locations was the only feature predictive of OWAF-free survival (hazard ratio = 3.8, p = 0.031). ConclusionsInjecting cement in all areas affected by acetabular metastases could prevent OWAF. Because survival following PCA is not negligible, completing an insufficient first PCA could help preserve patients’ quality of life.

Depression at Baseline is an Independent Risk Factor for Cognitive Decline in Patients on Peritoneal Dialysis: A Multicenter Prospective Cohort Study

Background:Depression has been recognized as a risk factor for cognitive impairment (CI) from cross-sectional datasets. This multicenter prospective study investigated the association between depression and cognitive decline in peritoneal dialysis (PD) patients.Methods:This multicenter prospective cohort study included 458 PD patients who were followed up for 2 years. The Modified Mini-Mental State Examination (3MS) was used for assessment of global cognitive function, Trail-Making Tests A and B for executive function, subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skill, and language ability. Depression was assessed using Zung's Self-Rating Depression Scale.Results:During the 2-year follow-up, patients with moderate/severe depression at baseline showed a significant decline in global cognitive function (80.5 ± 15.2 vs 76.6 ± 15.5, p = 0.008), while patients without depression or with mild depression kept a stable global cognitive function. In the meantime, patients without depression showed significant improvements in immediate memory, visuospatial skill, and language ability. However, no significant improvement in these parameters was shown in depression groups. In multivariable linear regression analysis, depression at baseline was a significant predictor of worsening global cognitive function, whether depression was analyzed as a continuous variable (odds ratio [OR] = -0.14, 95% confidence interval [CI] -0.27, -0.01, p = 0.031) or a rank variable (OR = -1.88, 95% CI -3.30, -0.45, p = 0.010). Moreover, higher depression score or more severe depression degradation was significantly associated with decline of immediate memory, delayed memory, and language skill.Conclusion:Depression was a significant risk factor for worsening of CI in PD patients.

708-P: Effectiveness of CHO-Counting on Glycometabolic Control and Comparison between the Methods of I/CHO Ratio Calculation in Subjects with Cystic Fibrosis-Related Diabetes (CFRD)

DM is a complication of cystic fibrosis and it’s caused mainly by insulin deficiency. A glycometabolic decompensation, due to incorrect therapeutic management, leads to a worsening of the catabolic state (already caused by malabsorption and high metabolic requests, and a known risk factor for worsening of respiratory function). The therapy for CFRD is insulin. Cho-counting, an effective technique to manage insulin therapy in T1DM subjects, allows patients to achieve a better glycemic control. Aim: to evaluate the efficacy of cho-counting in patients with CFRD on glycemic control. Materials and Methods: 21 patients with CFRD, randomized in 2 groups. gr.1: 9 patients performing cho-counting; gr.2: 12 patients followed according to ambulatory standard care. Glycometabolic control was evaluated with: a. variation of HbA1c, b. variation of pre and postprandial average SMBG in a period of 12 months. In group 1, the I/CHO ratio obtained with the 500-formula was compared with those obtained from food and glucose diaries. Results: gr.1 showed a reduction of HbA1c, compared to gr. 2 (7.4 ± 0.9% to 6.6 ± 0.3%, Δ -0.8% vs. 7.4 ± 1.5% to 7.5 ± 1.4%, Δ + 0.1%, P &amp;lt;0.05). There was also an improvement, even if not significant, in gr.1 and a worsening (p &amp;lt;0.05 for post) in gr.2, of pre and post-prandial average SMBG. In gr.1, the I/CHO ratio obtained through the 500-formula was 1/20. Based on diaries, it was 1/18 for breakfast, 1/25 for lunch and 1/25 for dinner. Conclusions: Cho-counting is effective in improving glycometabolic control in individuals with CFRD, avoiding the risk to worsen the already delicate metabolic balance of these patients. The use of dietary and glycemic diaries allows to estimate the I/CHO ratio differentiating the insulin needs during the day. This allows a more accurate personalization of the therapy compared to the use of 500-formula, which, in these patients, often overestimate the need for insulin at meals. Disclosure V. Grancini: Board Member; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Merck Sharp &amp; Dohme Corp. A. Gaglio: Consultant; Self; Roche Diabetes Care. V. Resi: Speaker's Bureau; Self; Sanofi. E. Palmieri: Speaker's Bureau; Self; Eli Lilly and Company. E. Orsi: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S, Sanofi-Aventis.