Significant Differences In History Research Articles

Concussion Characteristics in Adults With ADHD Seen in a Specialty Concussion Clinic.

Concussions are a prevalent health concern, affecting millions of individuals in the United States yearly. Concussion symptomology overlaps with other conditions making diagnosis and management particularly challenging, particularly among individuals with ADHD. ADHD is a neurodevelopmental disorder that affects a significant portion of the adult population. To enhance our understanding of symptom resolution and identify factors that could influence concussion care management, the purpose of the current study was to examine the recovery trajectory of adults diagnosed with both ADHD and concussion compared to the trajectory of adults who have experienced a concussion but do not have an ADHD diagnosis. The study included a retrospective chart review of patients treated for concussion at a concussion specialty clinic. The findings of the study revealed no significant differences in history of concussion or recovery time between patients with and without ADHD. It was observed that patients with ADHD had a higher prevalence of anxiety, depression, and other mental health conditions. The findings of the current study underscore the need for additional research to guide the care of patients diagnosed with both ADHD and concussion.

Abstract 131: Association Between Left Ventricular Injury Detected by Cardiac MRI and Incident Ischemic Stroke: The Multi-Ethnic Study of Atherosclerosis

Background: The association between left ventricular injury (LVI) detected by cardiac magnetic resonance imaging (CMR) and the risk of a subsequent ischemic stroke is unknown. Methods: We studied stroke-free participants in the Multi-Ethnic Study of Atherosclerosis study who underwent a steady-state free precession CMR at Exam 5 (2010-2012). The exposure of interest was LVI defined by either LV ejection fraction (EF) < 50% or circumferential strain > -10 in any LV apical wall. The primary outcome was incident ischemic stroke. We performed Cox proportional hazard analysis to model the association between LVI and incident ischemic stroke, adjusting for demographic and clinical covariates. Results: The analytic sample consisted of 2,584 participants (n=302 or 11.7% with LVI, n=2,282 or 88.3% without LVI). There were a total of 18 ischemic stroke events among those with LVI (6%) and 65 among those without LVI (3%). Participants with LVI were significantly older, male, Black, had higher BMI, and lower HDL. Participants with LVI were more likely to have diabetes, tobacco use, and atrial fibrillation (24% versus 14%, p<0.001). There was no significant difference in history of cardiovascular disease events (6% versus 4%, p=0.143). LVI was significantly and independently associated with incident ischemic stroke (adjusted hazard ratio 1.80, 95% C.I. 1.04-3.12). When participants were stratified into 3 mutually exclusive groups of no LVI, LVEF > 50% and LV apical circumferential strain < -10, and LVEF < 50% and LV apical circumferential strain > -10, the hazard of incident ischemic stroke was significantly higher for each of the two latter groups compared to the no LVI group (log-rank p-value=0.003; Figure 1 ). Conclusion: LVI identified by CMR is a significant, independent predictor of incident ischemic stroke. LV apical circumferential strain > -10% may be a novel and quantitative stroke risk factor. Further studies are needed to validate these CMR biomarkers of stroke risk.

Analysis of the Construction of a Predictive Model for Eosinophilic Chronic Rhinosinusitis.

This study aimed to determine indices to diagnose and predict eosinophilic chronic rhinosinusitis (ECRS) during the initial clinic visit. We retrospectively analyzed 116 patients with chronic rhinosinusitis who underwent endoscopic sinus surgery and were classified according to the postoperative pathological diagnosis. General data and various clinical indicators were analyzed, and indicators with statistically significant differences between groups were further incorporated into a multivariate logistic regression to establish a comprehensive prediction model. The receiver operating characteristic (ROC) curve was used to compare the two significant valuable single factors from previous studies, the difference in CT scores between the ethmoid sinus and the sum difference of the maxillary sinus (EM difference) and the absolute value of peripheral blood eosinophil (bEOS), with a comprehensive prediction model. There were significant differences in history of allergic asthma (p < 0.001), visual analog scale (VAS) score (p=0.005), sino-nasal outcome test-22(SNOT-22) scale score (p=0.004), Lund-Mackay scale score (p=0.017), EM difference (p=0.002), percentage of bEOS (%)(p=0.001), and absolute value of bEOS (×109/L) (p=0.000) between the two groups (p< 0.05). The history of allergic disease, VAS and bEOS were screened out and included in the comprehensive prediction model. The area under the curve (AUC) of the comprehensive prediction model (0.804)> the AUC of the absolute value of the bEOS (0.764)>the AUC of the EM difference (0.655). The AUC of the EM difference and the comprehensive prediction model were statistically different (P=0.025). There was no statistical difference between the absolute value of bEOS and the AUC of the comprehensive prediction model. The comprehensive prediction model covering the three aspects of allergic asthma history, VAS score, and bEOS count had the highest AUC compared to the other predictors and had good predictive power for the diagnosis of ECRS.

Evaluation of Risk Factors in Patients with Primary Open Angle Glaucoma and Ocular Hypertension

Objective: The purpose of our study was to compare the age, gender, intraocular pressure (IOP), central corneal thickness (CCT), spherical equivalent values, smoking, family history of glaucoma and additional systemic diseases in patients with primary open angle glaucoma (POAG) and patients with ocular hypertension (OHT); and to evaluate the relationships of these factors with each other. Material Methods: 40 patients with POAG, 40 patients with OHT and 40 individuals as control group were included in the study. Age, gender, IOP, CCT, spherical equivalent values, family history of glaucoma, history of consanguineous marriage, smoking, systemic diseases of each subject were recorded. Results: There was no significant difference in gender and average age between the groups (p=0.238 and p=0.51, respectively). IOP values was higher in POAG and OHT groups compared with the control group (p=0.000). CCT was higher in OHT group compared with the other groups (on the right, p=0.001 and p=0.008, respectively; on the left, p=0.013 and p=0.006, respectively). There was no significant correlation between IOP and CCT values. There was no significant difference in mean spherical equivalent values (on the right eye p=0.686; on the left eye p=0.640) . The incidence of diabetes mellitus, hypertension, hyperlipidemia and coronary artery disease was the similar in all groups (p=0.417, p=0.058, p=0.79, p=0.236, respectively). Family history of glaucoma is increased in POAG and OHT group compared with the control group (p=0.000). There was no significant difference in history of consanguineous marriage, smoking and alcohol consumption status among all groups (p=0.899, p=0.492, p=0,899, respectively). Conclusion: High IOP is the most important risk factor in the POAG and OHT groups. Individuals with OHT and thin CCT are at higher risk of developing POAG. The significant presence of a familial history of glaucoma in the POAG and OHT groups indicates that genetic factors could be a significant risk factor. Diabetes, hypertension, and high myopia are factors that increase the risk of glaucoma.

Long-Term Outcomes of Sleeve Gastrectomy: Weight Recurrence and Surgical Non-responders.

Sleeve gastrectomy (SG) is an effective procedure with remarkable weight loss and low complication rates. However, up to 30% of cases require revisional surgery in non-responders or patients who experience weight recurrence. We aim to report the rate of weight recurrence/non-responders (WR/NR) in patients who underwent SG and had more than 5 years of follow-up. We performed a multicenter retrospective study of patients who underwent initial SG from 2008 to 2017. Patient demographics and weight loss outcomes up to 12 years after SG were collected. Surgical non-responders were defined as 20% weight regain compared to maximum weight loss. A chi-square test for categorical variables and a two-sample t-test for continuous variables were used. Data are summarized as mean ± standard deviation. From a total of 1263 patients, we included 339 patients (78% female, age 47.3 ± 11.2 years; baseline weight 125.8 ± 27.6 kg) with at least 5 years of follow-up (mean follow-up of 7.1 ± 1.8 years) (Table 1). Surgical non-response was demonstrated in 15.9% of patients (n=54) and 64.0% (n=217) had weight recurrence after SG (Fig. 1). There was a statistically significant difference in history of hypertension (p=0.046) and diabetes (p=0.032) as well as %TBWL at 1 year (p=0.005) and at longest follow-up (p<0.001) between patients who experienced WR/NR and those who did not. Only 20% of patients who underwent SG and followed up for more than 5 years were able to maintain appropriate weight loss.

Evaluation of the relationship between clinical and laboratory risk factors in atherosclerosis patients with coronary slow flow: a case–control analysis

BackgroundCoronary slow flow (CSF) is an angiographic entity distinguished by the delayed filling of the epicardial coronary arteries in the lack of significant obstructive artery disease. The pathological causes are still unknown. This study aimed to elucidate the relationship between clinical and laboratory-related risk factors in atherosclerosis patients diagnosed with CSF.ResultsThe research encompassed a study group of 142 individuals, with a mean age of 52.47 ± 10.62, and a male representation of 47.7%. A thorough statistical analysis was conducted, indicating that there were no noteworthy variations in age, gender, smoking history, hematocrit, blood sugar, and HDL levels between the groups of cases and controls (P > 0.05). Subsequent analysis of the data indicated that there were significant differences in history of hypertension, LDL, and BMI measurements between the groups of subjects who were designated as cases and those who were designated as controls. Our study revealed that male gender, a history of hypertension, and BMI were identified as independent predictors of CSF (P < 0.05).ConclusionsAfter modeling regression, we were able to conclude that male gender, BMI, and history of hypertension are reliable predictors of slow coronary flow. These findings add to our growing understanding of the complex interplay between clinical and laboratory risk factors in the development and progression of CSF.

PO-02-094 ALL PULMONARY VEIN ISOLATION STRATEGIES ARE EQUALLY EFFECTIVE IN REDUCING THE RECURRENCE OF ATRIAL ARRHYTHMIAS

Ostial and antral pulmonary vein isolation techniques have different properties. In addition, there are differences between radiofrequency and cryoballoon ablation based on tissue contact characteristics. Finally, posterior wall isolation (PWI) has been proposed as an adjuvant to PVI because of embryological origin similarities. We examine the results of ostial and antral RF ablation, cryoballoon PVI and PWI adjunction in the DECAAF-II trial with regard to the recurrence of atrial arrhythmias after ablation. Patients with persistent AF from the DECAAF-II trial who underwent PVI only or PVI + PWI were included. All patients underwent LGE-MRI before ablation and 3 months after ablation. The electroanatomic maps at time of procedure displaying the location of ablation lesions were merged with baseline LGE-MRI images, and two reviewers analyzed and classified the resulting reconstructions. PVI were classified as ostial if the lesions were in the immediate proximity of the pulmonary veins’ ostium and as antral if the lesions included a portion of the antrum around the pulmonary veins. Patients with PVI + PWI were extracted as a separate group. Patients were followed up for a total of 18 months using daily single-lead smartphone ECG strips. The primary outcome of this analysis was recurrence of atrial arrhythmias after the 90-day blanking period. A total of 367 patients were considered for analysis. 211 patients underwent ostial PVI, 81 antral PVI, 31 had PVI + PWI, and 44 underwent cryoablation. Baseline characteristics were comparable in terms of age, sex, fibrosis percentage, comorbidity profile (hypertension, diabetes, hyperlipidemia, CAD, history of stroke), and medication history, except for a significant difference in history of heart failure (10.4% vs. 18.5% vs. 29% vs. 27.3%, p = 0.004) and prior AAD use (46.9% vs. 44.4% vs. 64.5% vs. 29.5%, p = 0.026). Recurrence rates were comparable among the four groups: 91 (43%) patients had recurrence in the ostial PVI group, 39 (48%) in the antral PVI group, 12 (39%) in the PWI group, and 22 (50%) in the cryoablation group (log rank P=0.76). In patients with persistent AF, all PVI techniques show equal efficacy in terms of atrial arrhythmia recurrence. Isolation of the posterior wall during ablation in persistent AF has no procedural advantage.

Late-gadolinium enhancement is common in older pediatric heart transplant recipients and is associated with lower ejection fraction

BackgroundChronic graft failure and cumulative rejection history in pediatric heart transplant recipients (PHTR) are associated with myocardial fibrosis on endomyocardial biopsy (EMB). Cardiovascular magnetic resonance imaging (CMR) is a validated, non-invasive method to detect myocardial fibrosis via the presence of late gadolinium enhancement (LGE). In adult heart transplant recipients, LGE is associated with increased risk of future adverse clinical events including hospitalization and death. We describe the prevalence, pattern, and extent of LGE on CMR in a cohort of PHTR and its associations with recipient and graft characteristics. MethodsThis was a retrospective study of consecutive PHTR who underwent CMR over a 6-year period at a single center. Two independent reviewers assessed the presence and distribution of left ventricular (LV) LGE using the American Heart Association (AHA) 17-segment model. LGE quantification was performed on studies with visible fibrosis (LGE+). Patient demographics, clinical history, and CMR-derived volumetry and ejection fractions were obtained. ResultsEighty-one CMR studies were performed on 59 unique PHTR. Mean age at CMR was 14.8 ± 6.2 years; mean time since transplant was 7.3 ± 5.0 years. The CMR indication was routine surveillance (without a clinical concern based on laboratory parameters, echocardiography, or cardiac catheterization) in 63% (51/81) of studies. LGE was present in 36% (29/81) of PHTR. In these LGE + studies, patterns included inferoseptal in 76% of LGE + studies (22/29), lateral wall in 41% (12/29), and diffuse, involving > 4 AHA segments, in 21% (6/29). The mean LV LGE burden as a percentage of myocardial mass was 18.0 ± 9.0%. When reviewing only the initial CMR per PHTR (n = 59), LGE + patients were older (16.7 ± 2.9 vs. 12.8 ± 4.6 years, p = 0.001), with greater time since transplant (8.3 ± 5.4 vs. 5.7 ± 3.9 years, p = 0.041). These patients demonstrated higher LV end-systolic volume index (LVESVI) (34.7 ± 11.7 vs. 28.7 ± 6.1 ml/m2, p = 0.011) and decreased LV ejection fraction (LVEF) (56.2 ± 8.1 vs. 60.6 ± 5.3%, p = 0.015). There were no significant differences in history of moderate/severe rejection (p = 0.196) or cardiac allograft vasculopathy (CAV) (p = 0.709). ConclusionsLV LGE was present in approximately one third of PHTR, more commonly in older patients with longer time since transplantation. Grafts with LGE have lower LVEF. CMR-derived LGE may aid in surveillance of chronic graft failure in PHTR.

Abstract 13193: Prevalence of Late Gadolinium Enhancement Following Pediatric Heart Transplantation Increases With Time Since Transplantation

Introduction: Chronic graft failure in pediatric heart transplant recipients (PHT) is associated with myocardial fibrosis on explanted specimens. Cardiac magnetic resonance imaging (CMR) is a validated, non-invasive method to detect myocardial fibrosis via the presence of late-gadolinium enhancement (LGE). In adult heart transplant recipients, LGE is associated with increased risk of hospitalization and death. We describe LGE on CMR among PHT and its associations with clinical and graft characteristics. Methods: We performed a retrospective chart review of all PHT who underwent CMR over a 6-year period at a single center (81 CMR studies, 59 unique patients). Two independent reviewers assessed the presence and distribution of LGE using the AHA 17-segment model. Clinical history and CMR-derived volumetry/ejection fraction were obtained; differences between LGE+ and LGE- PHT were evaluated. Results: Mean age at CMR was 14.8±4.6y; mean time since transplant was 7.3±5.0y. CMR indication was routine surveillance (without active rejection or history of cardiac allograft vasculopathy) in 63% (51/81) of studies. LGE was present in 36% (29/81). LGE patterns included: posterior hinge-point 27% (22/81), lateral wall 15% (12/81), and extensive, involving &gt;4 AHA segments, 7% (6/81) (Figure). Reviewing initial CMR per PHT (n=59), LGE+ patients were older (17 vs. 13y; p=0.001), with greater time since transplant (8.3 vs. 5.7y; p= 0.041). They demonstrated increased indexed LV end-systolic volume (35 vs. 29 ml/m2; p=0.011) and decreased LV ejection fraction (56.2 vs 60.6%; p=0.015). There were no significant differences in history of moderate/severe rejection or cardiac allograft vasculopathy. Conclusions: LV LGE was seen in about a third of PHT patients, more commonly in older patients with longer time since transplantation. Grafts with LGE show remodeling with lower LV ejection fraction. CMR-derived LGE may improve surveillance of chronic graft failure in PHT.

More Opioids Associated with Persistent Postoperative Opioid Use in Crohn’s Disease

INTRODUCTION: Up to 70% of patients with Crohn’s Disease (CD) experience debilitating abdominal pain during flares and often live with chronic abdominal pain. Furthermore, ~70% will require at least 1 operation during their disease course, with 50% of patients requiring multiple operations. Between 13% and 50% of adults with inflammatory bowel disease (IBD) chronically use opioids to manage pain. Surgery poses challenges for management of both chronic abdominal pain and acute postoperative pain in patients with IBD. Despite being a high-risk group, there are limited studies investigating prescribing patterns and the clinical impact of postoperative opioid use in CD. METHODS: The study population consisted of 357 patients with CD who underwent disease-related major abdominal operation between January 2014 and December 2018. Persistent opioid use was defined as either: 1) visit to outpatient pain service within 1 year; or 2) continued opioid use within 1 year after operation. RESULTS: Of the patients studied, 56 (15.7%) patients had persistent postoperative opioid use and 301 (84.3%) patients did not. Patients with persistent opioid use were prescribed significantly (p < 0.0001) higher total morphine milligram equivalents (240.0 MME) on hospital discharge postoperatively compared with patients who did not have persistent use (225.0 MME). There was no significant difference in history of previous major abdominal operation, length of stay, laparoscopic vs open approach, or procedure between patients who did and did not have persistent use (Table). CONCLUSION: Patients with CD who are prescribed more opioids after disease-related major abdominal operation are more likely to have persistent opioid use within 1 year postoperatively. Table. - Patient Population Characteristics Characteristic Persistent use (n = 56) No persistent use (n = 301) p Value Sex, f, (%) 27 (48.2%) 126 (41.9%) 0.38 Age (years), median (range) 39 (30, 50.5) 34 (27, 47) 0.06 BMI (kg/m2), median (range) 21.8 (19.4, 25.0) 21.2 (18.6, 24.9) 0.42 Alcohol/Smoker/Drug Use, n (%) 8 (14.3%) 38 (12.6%) 0.67 Public Insurance, n (%) 4 (7.1%) 24 (8.0%) 1.00 History of 1+ prior abdominal surgeries, n (%) 14 (25.0%) 72 (24.0%) 0.87 Length of Stay (days), median (range) 6 (5, 9) 6 (4, 8) 0.20 Laparoscopic (vs Open) Approach, n (%) 50 (89.3%) 274 (91.0%) 0.62 Total MME Prescribed, median (range) 240.0 (225.0, 570.0) 225.0 (157.5, 240.0) <.0001

Clinical and neurophysiological patterns of early presenting symptoms in acute onset chronic inflammatory demyelinating polyradiculoneuropathy

The phenotypes of chronic inflammatory demyelinating polyneuropathy (CIDP) include an acute-onset phenotype (A-CIDP) with an evolution time of less than eight weeks from the onset of symptoms. This entity can be confused with Guillain-Barre syndrome of the acute inflammatory demyelinating variety (AIDP), delaying the start of treatment. To analyze the clinical and electrophysiological differences between A-CIDP, classic CIDP and AIDP, in order to identify factors that may help in the early differential diagnosis. A cross-sectional study was carried out with patients seen at the neuromuscular disease clinic of the National Institute of Neurology and Neurosurgery with a diagnosis of CIDP according to the criteria of the European Federation of Neurological Societies and Peripheral Nerve Society. Patients with CIDP <8 weeks were categorized as A-CIDP and were compared with patients diagnosed with classic CIDP and AIDP. Clinical, paraclinical and electrophysiological variables were obtained and analyzed. Significant differences in history of infection, cranial nerve involvement and dysautonomia were observed between A-CIDP and AIDP. Electrophysiological recordings reported significant differences in motor nerve conduction velocity and sural nerve recordings, being lower in the A-CIDP group. A history of infection, cranial nerve involvement and dysautonomia are important parameters to take into account for the differential diagnosis of these entities. Electrophysiological analysis is similar between A-CIDP and CIDP. The differential diagnosis between these types of demyelinating polyneuropathy must be based on clinical assessment.

Impact of biological sex on the outcomes of spinal cord stimulation in patients with chronic pain.

Spinal cord stimulation (SCS) continues to gain increasing popularity in the pain management field for the treatment of different painful conditions; however, to-date, the correlation between the SCS effectiveness and biological sex has not been fully established. We aimed to investigate the correlation between the biological sex and SCS outcomes. Following Institutional Review Board approval, a retrospective cohort study was performed by collecting data for patients treated with SCS at a tertiary academic center between the years 2002 and 2019. Data was assessed with multivariable linear regression to investigate the association between biological sex and pain scores at baseline, 6-, and 12-months following SCS implantation. Propensity score matching (PSM) was performed based on a set of covariates including age, duration of pain, time since implant, BMI, opioid medications use, smoking, depression and history of alcohol, or substance abuse. Of the patients treated with SCS implants, 418 patients fit the inclusion and exclusion criteria, out of which the majority were females (272, 65%). The pre-matching data reported a significant difference in history of diabetes and depression and was also significant for greater opioid use in male patients at baseline, 6-, and 12-months post-SCS implant. Propensity score matching (PSM) was performed based on the above mentioned covariant. After matching, no statistical difference was found among the variables, in both groups. Furthermore, after matching no significant differences in the pain scores at baseline, 6-, and 12-months post-SCS implant were observed. No biological sex-based differences in the analgesic response to SCS therapy was detected at 6- and 12-months post-SCS implant between groups with similar demographics, biomedical, and psychological values.

Factors influencing development of non-cardiac chest pain after endoscopic submucosal dissection for esophageal neoplasms: a retrospective case-control study of 309 patients from a single center.

Endoscopic submucosal dissection (ESD) is widely used for early stage esophageal cancer and precancerous lesions. Non-cardiac chest pain (NCCP) is a frequent complication of ESD. However, little is known about its incidence and associated factors. This study investigated the pain incidence and predictive factors for pain development after ESD for esophageal neoplasms. We enrolled a total of 309 patients with esophageal neoplasms, who underwent ESD in our center from January 2018 to June 2019. Sociodemographic and clinicopathological information for all patients was collected, and patients were divided into either a pain-free group (n = 156) or a pain group (n = 153) according to whether there was onset of NCCP 24-48hours after surgery. We made comparisons between groups using Student's t test or the χ2 test. Logistic-regression analysis was used to screen for risk factors. There were statistically significant differences in histories of previous surgery (P = 0.039), lesion size (P = 0.026), operation time (P = 0.009), and postoperative fever (P = 0.001). History of previous surgery (P = 0.043) and postoperative fever (P = 0.007) were independent risk factors for chest pain after esophageal ESD treatment. Chest pain and fever prolonged postoperative hospitalization time (P = 0.005, P = 0.001) and increased hospitalization cost (P = 0.034, P < 0.001). A history of previous surgery and postoperative fever was associated with the occurrence of NCCP after ESD in patients with esophageal neoplasms. NCCP and fever after esophageal ESD increased both hospitalization time and cost.

New-onset atrial fibrillation during acute coronary syndromes in Tunisian population: Incidence and predictive factors

New-onset atrial fibrillation (NOAF) frequently complicates acute coronary syndromes (ACS) leading to adverse short and long-term outcomes. The reported incidence ranges from 4 to 22% and a number of factors have consistently been shown to be associated with NOAF. To determine the incidence of NOAF in a Tunisian population admitted for ACS, and to identify its predictive factors. We performed a prospective observational cohort study including consecutive patients admitted to a single center for ACS over a one-year period. According to the NOAF occurred during hospitalization, the patients were divided into two groups: the NOAF and the non-NOAF group. We included 402 patients. The incidence of NOAF was 9.7% in ACS Tunisian patients. NOAF was more frequent in older patients ( P = 0.001) and in those with previous renal failure ( P < 0.001), stroke ( P = 0.009) and ischemic cardiomyopathy ( P = 0.02). During hospitalization, patients with NOAF more often had heart failure ( P = 0.01) and higher values of serum uric acid ( P = 0.001), peak creatinine ( P = 0.001), CRP ( P = 0.02), neutrophil to lymphocyte ratio ( P = 0.04) and mean platelet volume (MPV, P = 0.02). On echocardiography, they had greater indexed left atrial volume ( P = 0.02) and systolic arterial pulmonary pressure ( P = 0.03) while left ventricular ejection fraction (LVEF: 43 ± 12% vs 48 ± 10%, P = 0.01) was significantly lower. Hemoglobin (119 ± 1.8 g/l vs 130 ± 1.9 g/l, P = 0.001) was significantly lower in the NOAF group than the non-NOAF group. There were no significant differences in history of hypertension, diabetes, heart failure or pulmonary disease. In multivariate analysis, age (OR = 1.08; P = 0.02), MPV (OR = 1.4; P = 0.03), LVEF (OR = 2; P = 0.001) and indexed left atrial volume (OR = 1.15; P = 0.004) remained independent predictors of NOAF. Age, LVEF, MPV and indexed left atrial volume are risk factors for incident NOAF in Tunisian patients admitted for ACS.

Commentary on "Outcomes of Endovascular Stent Graft Repair for Penetrating Aortic Ulcers with or without Intramural Hematoma"

Penetrating Aortic Ulcer (PAU) is a kind of Acute Aortic Syndrome (AAS). Compared with PAUs without IMH, PAUs with Intramural Hematoma (IMH) presented significant differences in history of acute coronary syndrome, pleural effusion, emergency admitted, aortic diameter at the PAU level, and the occurrence of Stent-Induced New Entry (SINE). The cumulative survival rates of patients undergoing endovascular repair during the first hospitalization were significantly higher than those having delayed repair during the follow-up.

Diagnostic Accuracy of Suspected Appendicitis: A Comparative Analysis of Misdiagnosed Appendicitis in Children.

When evaluating suspected appendicitis, limited data support quality benchmarks for negative appendectomy (NA); none exist for delayed diagnosis of appendicitis (DDA). The objectives of this study are the following: (1) to provide preliminary evidence supporting a quality benchmark for DDA and 2) to compare presenting features and diagnostic evaluations of children with NA and DDA with those with pathology-confirmed appendicitis (PCA) diagnosed during initial emergency department (ED) encounter. Secondary analysis of data from a QI project designed to reduce the use computed tomography when evaluating suspected appendicitis using a case-control design. Patients undergoing appendectomy in an academic tertiary care children's hospital system between January 1, 2015, and December 31, 2016 (n = 1,189) were eligible for inclusion in this case-control study. Negative appendectomy was defined as no pathologic change or findings consistent with a different diagnosis. Delayed diagnosis of appendicitis was defined as patients undergoing appendectomy within 7 days of a prior ED visit for a related complaint. Controls of PCA (n = 150) were randomly selected from all cases undergoing appendectomy. There were 42 NA (3.5%) and 31 DDA (2.6%). Cases of PCA and NA exhibited similar histories, examination findings, and underwent comparable diagnostic evaluations. Cases of PCA more frequently demonstrated a white blood cell count greater than 10 × 103/μL (85% vs 67%; P = 0.01), a left-shift (77% vs 45%; P < 0.001), and an ultrasound interpretation with high probability for appendicitis (73% vs 54%; P = 0.03). Numerous significant differences in history, examination findings, and diagnostic tests performed existed between cases of PCA and DDA. Children with PCA and NA present similarly and undergo comparable evaluations resulting in appendectomy. A 3% to 4% NA rate may be unavoidable given these similarities. Presenting features in DDA significantly differ from those of PCA. An irreducible proportion of appendicitis diagnoses may be delayed.

Abstract 14559: Prognostic Utility of Cardiac Markers in Covid-19 Patients

Introduction: SARS-CoV-2 infection has been associated with a multiple cardiovascular complications. It is not known if cardiac markers can be used for outcome prediction in the US population. Methods: We conducted a retrospective study on patients ≥ 18 years old with confirmed COVID 19, who were admitted to our hospital between 03/15/2020 and 05/25/2020. Individuals were included if they had a baseline troponin and brain natriuretic peptide (BNP) available, and if their outcome by the end of the study period was well defined as discharge alive, or deceased. Univariate and multivariate logistic regression methods were employed to identify the cardiac markers associated with mortality in COVID-19 patients. Results: The total number of confirmed COVID-19 hospitalized patients during the study period was 348, after excluding patients who did not have cardiac markers available, 233 patients were included in the study, 75 (32%) expired, and 158 (68%) were discharged alive. The median age was 65 years old, and ranged from 22 to 101 years old. 140 males and 93 females. Comorbidities were present in 201 (86%) patients, with hypertension (65%) being the most common, followed by obesity (55%), diabetes mellitus (DM) (44%) and coronary artery disease (27%). Mechanical ventilation was required for 61 patients of whom 42 expired. In univariate analysis, we found a significant difference in history of chronic kidney disease defined by eGFR &lt;45ml/min (p=0.046), DM (p=0.043), initial SOFA (p=0.017), troponin (p=0.001), BNP (p=0.043), CRP (p=&lt;0.0001), LDH (p=&lt;0.0001) and ferritin (p=&lt;0.0001) between survivors and non-survivors. With multivariable logistic regression analysis, the only values that had an odds of survival were a low troponin (odds ratio [OR] 0.17; 95% confidence interval [CI], 0.04-0.52), a low SOFA (OR 0.72, CI 0.50-0.94) and a low CRP (OR 0.87, CI 0.87-0.94). Conclusions: This retrospective cohort study of hospitalized patients with COVID-19 suggests an independent association of increased troponin as risk factor for death in COVID-19 patients. Cardiac troponin has been reported as potential prognostic marker in the China cohort. To our knowledge, we are first to demonstrate the utilization of troponin as mortality predictor in the US population.

Risk Factors for Intra-Articular Bone and Cartilage Lesions in Patients Undergoing Surgical Treatment for Posterior Instability

Objectives:Patients with posterior shoulder instability often present with significant differences in history of injury and complaints compared to anterior instability that can lead to challenges in diagnosis and treatment. These patients may have bone and cartilage lesions in addition to caspulolabral injuries, though the risk factors for these intra-articular lesions are unclear. The purpose of this study was to describe intraoperative incidence of glenohumeral bone and cartilage lesions in a cohort of patients undergoing primary posterior stabilization using data from a prospectively collected, multicenter shoulder instability cohort. We hypothesized that patients with traumatic posterior instability with greater number of instability events would have higher rate of bone and cartilage injuries compared to those without fewer instability episodes.Methods:Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group instability patient cohort was utilized for this study. This is a multi-center study encompassing a prospective evaluation of patients ages 12 to 99 years of age undergoing primary surgical treatment for shoulder instability by 24 orthopedic surgeons at 11 sites in the United States. Demographic data and specifics regarding the patient’s instability history were recorded, including patient age, sex, body mass index (BMI), history of smoking, and Beighton score. The number of instability events was classified as 0, 1, 2 to 5, or more than 5. The duration of symptoms was classified as <1 month, 1-3 months, 4-6 months, 7-12 months, or greater than 1 year. The glenohumeral joint was evaluated by the treating surgeon at the time of surgical treatment for bone and cartilage injuries, and patients were classified as having a bone or cartilage lesion (BCL) if there was any grade 3 or 4 glenoid or humeral cartilage lesion, reverse Hill-Sachs lesion, bony Bankart lesion, or glenoid bone loss. The effects of number of instability events on the presence of BCLs was investigated using Fisher’s exact tests. Multivariate analysis using logistic regression modeling was performed to investigate the independent contributions of demographic variables and injury-specific variables to the likelihood of having a BCL. Significance was defined as p<0.05.Results:There were 271 patients identified for analysis. Bone and cartilage lesions were identified in 59 patients (21.8%) at the time of surgical treatment (Table 1). The most common lesion was a glenoid cartilage injury, which was identified in 28 patients (10.3%). Patients with BCLs were significantly older and had significantly higher BMI relative to patients without BCLs (Table 2). There was a significant difference between the number of instability events and the presence of BCLs (p = 0.035), with the highest rate observed in patients with 2-5 instability events (33.9%) (Figure 1). Through multivariate logistic regression modeling, increasing age (p=0.002), increasing BMI (p=0.012), and 2 to 5 reported instability events (p=0.001) were significant independent predictors of the presence of BCLs.Conclusion:Bone and cartilage lesions are seen significantly more frequently with increasing patient age, increasing BMI, and patients with 2-5 instability events. Early surgical stabilization for posterior instability may be considered to potentially limit the extent of associated intra-articular injury.Table 1.Frequency of Bone and Cartilage Lesions Identified in Patients Undergoing Primary Surgery for Posterior InstabilityIntra-Articular Lesion N % Glenoid cartilage injury*2810.3%Humeral cartilage injury*207.4%Reverse Hill-Sachs165.9%Glenoid bone loss114.1%Bony Bankart83.0%Any bone or cartilage lesion5921.8%*Indicates Outerbridge Grade 3 or 4 lesionsTable 2.Comparison of Patients With and Without Bone and Cartilage Lesions No Bone/Cartilage Lesion (N = 212) Bone/Cartilage Lesion (N = 59) Mean or N Standard Deviation or % Mean or N Standard Deviation or % P Value Age (Years)22.87.726.19.60.025Body Mass Index (kg/)26.34.628.65.20.0014Male Sex (N)17381.6%5084.8%0.70Smoker (N)73.3%46.8%0.26Hyperlax (Beighton >4)5224.5%915.3%0.16Pre-Operative Kerlan-Jobe Score49.321.842.418.30.094Pre-Operative WOSI Score43.618.438.917.70.11Pre-Operative SAS13.04.514.14.20.13WOSI: Western Ontario Shoulder Instability; SAS: Shoulder Activity ScoreFigure 1.

A study of factors related to asthma exacerbation using a questionnaire survey in Niigata Prefecture, Japan.

As indices of asthma control, exacerbations are equally important with symptoms and respiratory function. Thus, it is critical to recognize the risk factors of exacerbation. We conducted a questionnaire survey of asthma patients in Niigata Prefecture to clarify the factors involved in asthma exacerbation. The questionnaire survey was carried out in patients and their physicians from September to October 2014. In 2015, the same sample population also received a questionnaire about current asthma control and exacerbation. One hundred patients experienced asthma exacerbation during the 1-year period. There were significant differences in age, sex, history of hospitalization due to asthma, smoking history, Asthma Control Test, treatment step, and transient steroid treatment history in the previous year between the exacerbation group and non-exacerbation group. On multivariate analysis, there was a significant difference in history of transient steroid therapy, history of hospitalization associated with asthma attacks, and nonsmoking history. Cluster analysis of cases with exacerbation was classified into three clusters. Cluster 1 comprised slightly older cases with smoking history, Cluster 2 had more females, non-smoking and nonatopic cases with uncontrolled symptoms, and Cluster 3 had more females, non-smoking and mild atopic cases. Our findings suggest that patients with asthma exacerbation in the previous year and nonsmoking females are important targets for the study of asthma exacerbation. The adequate treatment of women patients might be important for the prevention of asthma exacerbation.

Mini-Incision Open Appendectomy with Incision Skin Tissue Retractor vs. Laparoscopic Appendectomy: A Retrospective Study of the Management of Child Acute Appendicitis.

IntroductionThis study aims to compare the clinical effects of an incision skin tissue retractor for mini-incision open appendectomy and laparoscopic surgery for pediatric appendicitis.MethodsFrom January 2014 to July 2017, a total of 248 patients were included in the present study. Laparoscopic appendectomy was performed for 108 cases (LA group), and mini-incision open appendectomy with an incision skin tissue retractor was performed for 140 cases (MOA-ISTR group). Then, medical history, age, gender, operative duration, amount of bleeding during the operation, the determination of whether or not the appendix was perforated during the operation, hospitalization days, total cost of hospitalization, and complications after the operation (incision infection or intestinal obstruction) were compared. The SPSS 20.0 software package was used for the statistical analysis.ResultsThere were no statistically significant differences in history, age, gender, perioperative perforation of the appendix, postoperative hospital stay and postoperative complications (incisional infection or intestinal obstruction, P > 0.05). However, the values for duration of surgery, intraoperative blood loss and total hospitalization expense were smaller, when compared with the LA group (P < 0.05).ConclusionMini-incision open appendectomy with an incision skin tissue retractor has similar efficacy and incision appearance when compared with laparoscopic appendectomy. Furthermore, this approach leads to shorter operation time, less intraoperative blood loss and less hospitalization time, and is more convenient, especially for perforated appendicitis. Moreover, it can be widely used for pediatric appendicitis, and is more suitable for doctors who are not skilled in basic hospitals and laparoscopy.