Syndrome Status Research Articles

Association Between Sleep Duration and Stroke in Different Status of Metabolic Syndrome: A Cross-Sectional Study in Shanghai Adult Residents.

This study aimed to investigate the relationship between sleep duration (SD) and stroke, and examine the effects of SD on stroke with or without metabolic syndrome (Mets) and its components among the adult residents in Shanghai, China. A total of 20,245 participants (51.72% male, mean age 44.66 years) were included from Shanghai Chronic Disease and Risk Factors Surveillance (SCDRFS) in 2017. The weighted logistic regressions were performed to examine the associations between SD and stroke in different status of Mets and its components. The mean SD was 7.51±0.03 h/d. After adjusting for all the potential factors, SD<6 h/d (OR=1.73, 95% CI: 1.35-2.20) or ≥10 h/d (OR=1.66, 95% CI: 1.08-2.57) was significantly positively associated with stoke in the total participants; moreover, in the non-Mets group, only SD<6 h/d (OR=1.77, 95% CI: 1.19, 2.64) significantly increased the risk of stroke; while, in the Mets group, SD<6 h/d (OR=1.80, 95% CI:1.17-2.76) and ≥10 h/d (OR=1.97, 95% CI: 1.00-3.88) both had a positive significantly association with stoke. In addition, the effects of SD<6 h/d on stroke were more pronounced among those with high WC (OR=2.24, 95% CI: 1.40-3.58) and high TG (OR=2.60, 95% CI: 1.86-3.62), and the effects of SD≥10 h/d on stroke were more evident among those with high TG (OR=2.28, 95% CI: 1.02-5.08) and high FBG (OR=2.58, 95% CI: 1.30-5.10). Both short and long SD were significantly positively associated with stroke in the total participants, and the associations were stronger in the Mets group; conversely, in the non-Mets group, only short SD was significantly positively associated with stroke, and no significant association was observed between long SD and stroke. Therefore, more precise sleep measures may be needed to prevent stroke according to the different status of Mets.

Relationship between the Cycle Threshold Value (Ct) of a Salmonella spp. qPCR Performed on Feces and Clinical Signs and Outcome in Horses.

The objective of this retrospective study was to evaluate the clinical significance of fecal quantitative real-time polymerase chain reaction (qPCR) Salmonella results when taking the cycle threshold values (Ct) into account. The study included 120 Salmonella qPCR-positive fecal samples obtained from 88 hospitalized horses over a 2-year period. The mean Ct of the qPCR test was evaluated in regard to (1) clinical outcome and (2) systemic inflammatory response syndrome (SIRS) status (no SIRS, moderate SIRS, or severe SIRS) of the sampled horses. An ROC analysis was performed to establish the optimal cut-off Ct values associated with severe SIRS. The mean ± SD Ct value was significantly lower in samples (1) from horses with a fatal issue (27.87 ± 5.15 cycles) than in surviving horses (31.75 ± 3.60 cycles), and (2) from horses with severe SIRS (27.87 ± 2.78 cycles) than from horses with no (32.51 ± 3.59 cycles) or moderate (31.54 ± 3.02 cycles) SIRS. In the ROC analysis, the optimal cut-off value of Ct associated with a severe SIRS was 30.40 cycles, with an AUC value of 0.84 [95% confidence interval 0.76-0.91] and an OR of 0.64 [0.51-0.79]. Results suggest that including the Ct value in the interpretation of fecal qPCR results could improve the diagnostic value of this test for clinical salmonellosis in horses.

Trends in Natural Decannulation in Patients with Robin Sequence: A Twenty-five Year Retrospective Review.

Robin sequence (RS) consists of micrognathia and glossoptosis that result in upper airway obstruction (UAO). In RS patients who undergo tracheostomy, long-term goals include natural decannulation (ND) without further surgical airway intervention. The objective of this study was to identify long-term trends in the rate and length of time to ND. Retrospective chart review on 144 patients with RS treated from 1995 to 2020 at a pediatric tertiary care center. Patients were grouped by year of tracheostomy. Demographic data, UAO management, postoperative care, complications, and time to decannulation were recorded. Thirty-six patients met the inclusion criteria. Tracheostomy was performed at a median age of 45.5 days. 19 (53%) patients experienced ND at a median time of 66.1 months. ND rate was higher in non-syndromic patients (93% non-syndromic vs 27% syndromic; P < .0001) and during the first study period (1995-2006: 78%, 2007-2020: 28%; P = .003). Cox proportional-hazard regression demonstrated that white race [aHR 0.15 (0.03-0.8); P = .023] and higher birthweight [aHR 0.9 (0.8-0.98); P = .018] were associated with a higher likelihood of ND while a syndromic diagnosis had a negative association with ND [aHR 12.5 (3.3-50.0); P < .001]. Our study documented that ND in patients with RS who underwent tracheostomy was significantly associated with ethnicity, birthweight, and syndromic status. The negative impact on successful ND was most observed in patients with syndromic associations. Additionally, ND rates are lower in the 2007 to 2020 subgroup. We suspect this is because alternative management techniques such as tongue lip adhesion and mandibular distraction osteogenesis became primary surgical treatment in severe RS upper airway obstruction at our institution starting in 2007.

Independent effects of posttraumatic stress disorder diagnosis and metabolic syndrome status on prefrontal cortical thickness and subcortical gray matter volumes.

Posttraumatic stress disorder (PTSD) and metabolic syndrome (MetS) are associated with overlapping brain structural differences. These often involve brain structures involved in the regulation of appetite, food intake, satiety, and reward processing. We examined the individual and interactive effects of PTSD diagnosis and MetS on cortical thickness and subcortical gray matter volumes in patients with PTSD (n = 104) compared to trauma-exposed controls (n = 97). Multivariate models were constructed for FreeSurfer-generated prefrontal cortical thickness and subcortical gray matter regions-of-interest (ROIs) to explore the effects of PTSD diagnosis and MetS as predictors, adjusting for relevant socio-demographic and clinical covariates. Individual prefrontal cortical and subcortical limbic ROIs were also selected based on apriori evidence of their involvement in both PTSD and MetS. The mean age of the sample (n = 201; 78% female) was 41.6 (SD, 13.1) years. PTSD and MetS status showed independent associations with prefrontal cortical thickness and subcortical gray matter volumes across multiple ROIs, adjusting for age, sex, scanner sequence, alcohol, and tobacco use. PTSD and MetS are independently associated with brain structural differences, including thinner prefrontal cortical thickness and smaller subcortical gray matter volumes, across multipleROIs implicated in the hedonic and homeostatic regulation of food intake.

Survey of primary tooth eruption status of down syndrome in Japan: Comparison with the Japanese National Survey of Dental Diseases

IntroductionDown syndrome (DS) can cause irregular dental eruption patterns and hypodontia. However, data on primary tooth eruption with DS in Japan are insufficient. Therefore, this study aimed to conduct a questionnaire survey to predict dental abnormalities in DS based on tooth eruption status. MethodsA questionnaire survey on the age, sex, number of present teeth, and dental formula of patients with DS was conducted at facilities providing dental care for the disabled in Japan, and the results were compared with those of the Survey of Dental Diseases used as for the control survey. ResultsA total of 3656 valid responses were received. This study was analyzed according to the age group of the Survey of Dental Diseases. At 1–14 years old, the mean number of primary teeth per patient was the highest at 4 years old (19.3 teeth). The largest difference from the control survey was at 1 year old, and the difference decreased with age until 4 years. At 3–5 years old, the rate of individual primary tooth eruptions was 14.2% lower for the mandibular primary lateral incisors than that in the control survey. At 15 years old or older, the percentage of people who had persistence of primary teeth was 19.2%. The second primary molars were the most common persistent primary teeth. ConclusionDS is characterized by delayed tooth eruption, high incidence of missing teeth, particularly the mandibular primary lateral incisors, and persistence of primary teeth. These findings indicate the importance of developmental support and oral management.

Malnutrition- inflammation- atherosclerosis (MIA) syndrome associates with periodontitis in end-stage renal disease patients undergoing hemodialysis: a cross-sectional study

Malnutrition-inflammation-atherosclerosis (MIA) syndrome is a significant risk factor for mortality in patients undergoing hemodialysis. This study aimed to investigate the association between MIA syndrome and oral health status in hemodialysis patients. A cross-sectional study was conducted on 254 hemodialysis patients. Comprehensive medical and dental examinations were performed. Three components were included to define MIA syndrome: Geriatric Nutritional Risk Index, serum high-sensitivity C-reactive protein, and history of cardiovascular events as indicators of malnutrition, inflammation, and atherosclerosis, respectively. The association of MIA syndrome components with periodontitis and occlusal support was examined by multiple-ordered logistic regression analysis. Of 254 participants, 188 (74.0%) had at least one component of MIA syndrome. After adjusting for possible confounding factors, severe periodontitis was significantly associated with presence of more components of MIA syndrome (odds ratio [OR]: 2.64, 95% confidence interval [CI], 1.44–4.84, p = 0.002) and inflammation and malnutrition components (OR: 2.47 and 3.46, 95% CI 1.16–5.28 and 1.70–7.05, p = 0.020 and 0.001). On the other hand, occlusal support, evaluated by Eichner index, was not significantly associated with MIA syndrome or any of its components. In conclusion, periodontitis is associated with MIA syndrome, particularly with inflammation and malnutrition in hemodialysis patients, independent of occlusal support.

Gender differences in change of metabolic syndrome status and its components on all-cause and cause-specific mortalities: Over a decade follow-up study

BackgroundAccumulating evidence suggests a close association between metabolic syndrome (MetS) and excess risk of mortality. However, whether the dynamic change of MetS and its components could affect cause-specific mortalities and how this relation could be influenced by gender is yet to be clarified. Methods and resultsIn this longitudinal cohort, we entered 4904 Iranian adults>30 years (2820 women) from March-1999 and followed up until December-2018. MetS was determined using the joint interim societies (JIS) criteria. Due to change in MetS status over three years, we divided individuals into MetS-free, MetS-recovery, MetS-developed, and MetS-persistent groups. The same categories were defined for each MetS component. Multivariate Cox regression models were employed to compute the adjusted hazard ratios (HRs) and female-to-male relative HRs (F/M-RHRs) for risk of all-cause, cardiovascular (CV), non-CV, and cancer mortalities. To resolve reverse causation, mortalities during the first three years of follow-up were excluded. Subgroup analysis was conducted for non-diabetic and non-hypertensive participants.During 12.5 years of follow-up, 357 all-cause, 112 CV-, and 79 cancer-mortalities occurred. Compared to MetS-free, MetS-persistent raised all-cause- and CV-mortalities in both genders. Same association was found for non-diabetic (HR = 1.66 (1.03–3.00)) or non-hypertensive (HR = 1.89 (1.09–3.64)) women. Moreover, MetS-persistent women with neither hypertension nor diabetes had increased all-cause mortality risk by 88% (F/M-RHR = 3.99 (1.53–5.58)). Women with stable MetS had excess risk of cancer-mortality by 40% (F/M-RHR = 1.63 (1.02–5.06)). Generally, among both genders, recovery from MetS declined risk of mortality events. Regarding MetS components, persistent elevated fasting plasma glucose (FPG) was related to all-cause mortality in both genders, but with stronger association in women (F/M-RHR = 1.41 (1.11–2.49), and CV-mortality only in women (F/M-RHR = 3.04 (1.02–5.96). Both development and stable status of high blood pressure (BP) increased the risk of CV-mortality merely in women (F/M-RHR = 3.10 (0.60–6.87) and F/M-RHR = 3.24 (1.26–6.11), respectively). Development or recovery from each Triglyceride, HDL-C, and waist circumference variables did not solely affect risk of mortality events in both genders. ConclusionStable status of MetS could increase risk of mortalities with an overall stronger association in women. Although elevated BP and FPG are the main drivers for mortality risk, MetS among women could carry the corresponding effect even in absence of hypertension and diabetes.

An immuno-lipidomic signature revealed by metabolomic and machine-learning approaches in labial salivary gland to diagnose primary Sjögren's syndrome.

Assessing labial salivary gland exocrinopathy is a cornerstone in primary Sjögren's syndrome. Currently this relies on the histopathologic diagnosis of focal lymphocytic sialadenitis and computing a focus score by counting lym=phocyte foci. However, those lesions represent advanced stages of primary Sjögren's syndrome, although earlier recognition of primary Sjögren's syndrome and its effective treatment could prevent irreversible damage to labial salivary gland. This study aimed at finding early biomarkers of primary Sjögren's syndrome in labial salivary gland combining metabolomics and machine-learning approaches. We used a standardized targeted metabolomic approach involving high performance liquid chromatography coupled with mass spectrometry among newly diagnosed primary Sjögren's syndrome (n=40) and non- primary Sjögren's syndrome sicca (n=40) participants in a prospective cohort. A metabolic signature predictive of primary Sjögren's syndrome status was explored using linear (logistic regression with elastic-net regularization) and non-linear (random forests) machine learning architectures, after splitting the data set into training, validation, and test sets. Among 126 metabolites accurately measured, we identified a discriminant signature composed of six metabolites with robust performances (ROC-AUC = 0.86) for predicting primary Sjögren's syndrome status. This signature included the well-known immune-metabolite kynurenine and five phospholipids (LysoPC C28:0; PCaa C26:0; PCaaC30:2; PCae C30:1, and PCaeC30:2). It was split into two main components: the first including the phospholipids was related to the intensity of lymphocytic infiltrates in salivary glands, while the second represented by kynurenine was independently associated with the presence of anti-SSA antibodies in participant serum. Our results reveal an immuno-lipidomic signature in labial salivary gland that accurately distinguishes early primary Sjögren's syndrome from other causes of sicca symptoms.

Frequency of Metabolic Syndrome in Patients with Polycystic Ovarian Syndrome

Objective: To study the frequency of metabolic syndrome in patients with polycystic ovarian syndrome.Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the outpatient Department of Gynecology Unit-II from 1st September 2019 to 25th January 2020.Materials and Methods: Females aged 18 to 45 years were diagnosed with polycystic ovarian syndrome using Rotterdam criteria. The diagnosis of metabolic syndrome was made upon the Adult Treatment Panel criteria National Cholesterol Education Program Expert Panel, i.e., the presence of any three features like central obesity, dyslipidemia, hypertension, and elevated fasting blood sugar. All procedures were done by the researcher herself, and all data were recorded on a pre-designed questionnaire. Data was analyzed using SPSS version 25.Results: The average age of the females was 30.98±7.05 years, most of whom were married (96.62%). Out of the total 148 females, 64.83% were diabetic, 29.73% had hypertension, 69.59% had dyslipidemia, and 29% were obese. Out of 148 females with polycystic ovarian syndromes, metabolic syndrome was present in 27.70%. The frequency of metabolic syndrome was significantly higher among obese females compared to normal and overweight with p-value=0.001. However, metabolic syndrome showed no significant association with age, marital status, parity, and duration of polycystic ovarian syndrome (p&gt;0.05).Conclusion: Metabolic syndrome is a prevalent condition in females with polycystic ovarian syndrome and having a high BMI makes it more likely. These findings andsystematic investigation can be used to justify a metabolic syndrome screening policy in polycystic ovarian syndrome for early detection and intervention, as well as a healthy future.

Prognostic value of Lynch syndrome, BRAFV600E , and RAS mutational status in dMMR/MSI-H metastatic colorectal cancer in a pooled analysis of Dutch and French cohorts.

Current knowledge on prognostic biomarkers (especially BRAFV600E /RAS mutations) in metastatic colorectal cancer (mCRC) is mainly based on mCRC patients with proficient mismatch repair (pMMR) tumors. It is uncertain whether these biomarkers have the same prognostic value in mCRC patients with deficient mismatch repair (dMMR) tumors. This observational cohort study combined a population-based Dutch cohort (2014-2019) and a large French multicenter cohort (2007-2017). All mCRC patients with a histologically proven dMMR tumor were included. In our real-world data cohort of 707 dMMR mCRC patients, 438 patients were treated with first-line palliative systemic chemotherapy. Mean age of first-line treated patients was 61.9 years, 49% were male, and 40% had Lynch syndrome. BRAFV600E mutation was present in 47% of tumors and 30% harbored a RAS mutation. Multivariable regression analysis on OS showed significant hazard rates (HR) for known prognostic factors as age and performance status, however showed no significance for Lynch syndrome (HR: 1.07, 95% CI: 0.66-1.72), BRAFV600E mutational status (HR: 1.02, 95% CI: 0.67-1.54), and RAS mutational status (HR: 1.01, 95% CI: 0.64-1.59), with similar results for PFS. BRAFV600E and RAS mutational status are not associated with prognosis in dMMR mCRC patients, in contrast to pMMR mCRC patients. Lynch syndrome is also not an independent prognostic factor for survival. These findings underline that prognostic factors of patients with dMMR mCRC are different of those with pMMR, which could be taken into consideration when prognosis is used for clinical decision-making in dMMR mCRC patients and underline the complex heterogeneity of mCRC.

#6963 OBESITY, METABOLIC SYNDROME AND THE RISK OF ADVERSE CLINICAL OUTCOMES IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Obesity and metabolic syndrome are prevalent disorder in patients with chronic kidney disease (CKD). However, it is unclear whether obesity without metabolic syndrome is associated with higher risk of adverse clinical outcomes in patients with CKD. Method We reviewed the National Health Insurance Service database of Korea for people who received ≥2 national health screenings between 2009 and 2011. A total of 68,464 chronic kidney disease patients were identified with consecutive estimated glomerular filtration rate &amp;lt;60 ml/min per 1.73 m2. Obesity was defined as body mass index ≥25 kg/m2 and metabolic syndrome status was considered as the presence of three or more of the following metabolic factors; waist circumference, blood pressure, fasting blood sugar, triglyceride level, high-density lipoprotein cholesterol level. The primary outcomes were cardiovascular events, end-stage renal disease progression (ESRD) and all-cause mortality. Results Compared to non-obese patients without metabolic syndrome, obesity without metabolic syndrome did not increase the risk of cardiovascular event (HR 1.02, 95% CI 0.95–1.11) and progression to ESRD (HR 0.86, 95% CI 0.73–1.02). Risk of all-cause mortality was significantly decreased in these patients (HR 0.88, 95% CI 0.81–0.96). These findings were consistently observed in overweight, obese, morbid obese patients without metabolic syndrome. In addition, while linear increase of HRs for each additional metabolic abnormality was observed, HRs increase for cardiovascular event was significantly slower in obese patients than in non-obese (P for interaction = 0.035). Conclusion Obesity without metabolic syndrome did not confer excess risk for cardiovascular complication or ESRD progression and decreased the risk of all-cause mortality. Healthy effect of obesity against mortality risk and metabolic hazard on cardiovascular event is better to be considered in CKD patients.

A Comprehensive Summary of the Current Understanding of the Relationship between Severe Obesity, Metabolic Syndrome, and Inflammatory Status.

At present, obesity, as a part of metabolic syndrome, represents the leading factor for disability, and is correlated with higher inflammation status, morbidity, and mortality. The purpose of our study is to add new insights to the present body of knowledge regarding the correlations between chronic systemic inflammation and severe obesity, which cannot be treated without considering other metabolic syndrome conditions. Biomarkers of high-level chronic inflammation are recognized as important predictors of pro-inflammatory disease. Besides the well-known pro-inflammatory cytokines, such as WBCs (white blood cells), IL-1 (interleukin-1), IL-6 (interleukin-6), TNF-alpha (tumor necrosis factor-alpha), and hsCRP (high-sensitivity C-reactive protein), as well as anti-inflammatory markers, such as adiponectin and systemic inflammation, can be determined by a variety of blood tests as a largely available and inexpensive inflammatory biomarker tool. A few parameters, such as the neutrophil-to-lymphocyte ratio; the level of cholesterol 25-hydroxylase, which is part of the macrophage-enriched metabolic network in adipose tissue; or levels of glutamine, an immune-metabolic regulator in white adipose tissue, are markers that link obesity to inflammation. Through this narrative review, we try to emphasize the influence of the weight-loss process in reducing obesity-related pro-inflammatory status and associated comorbidities. All data from the presented studies report positive results following weight-loss procedures while improving overall health, an effect that lasts over time, as far as the existing research data show.

Clinical implications of changes in metabolic syndrome status after kidney transplantation: a nationwide prospective cohort study.

Metabolic syndrome (MetS) is prevalent in patients with end-stage kidney disease, and kidney transplantation is expected to modify the metabolic status. However, whether changes in metabolic status at the time of transplantation affect recipient outcomes remains unclear. We analyzed 4187 recipients registered in a nationwide prospective cohort from 2014 to 2020. MetS was defined as the presence of three or more components of the metabolic syndrome. Patients were classified based on the pre- and post-transplant MetS status: MetS-free, MetS-developed, MetS-recovered and MetS-persistent. Study outcomes were occurrence of death-censored graft loss and a composite of cardiovascular events and death. Among recipients without pre-transplant MetS, 19.6% (419/2135) developed post-transplant MetS, and MetS disappeared in 38.7% (794/2052) of the recipients with pre-transplant MetS. Among the four groups, the MetS-developed group showed the worst graft survival rate, and the MetS-persistent group had a poorer composite event-free survival rate. Compared with the MetS-free group, the MetS-developed group was associated with an increased risk of graft loss [adjusted hazard ratio (aHR) 2.35; 95% confidence interval (CI) 1.17-4.98] and the risk of graft loss increased with increasing numbers of dysfunctional MetS components. MetS-persistent was associated with increased risks of cardiovascular events and death (aHR 2.46; 95% CI 1.12-5.63), but changes in the number of dysfunctional MetS components was not. Kidney transplantation significantly alters the metabolic status. Newly developed MetS after transplantation was associated with an increased risk of graft loss, whereas persistent MetS exposure before and after transplantation was associated with increased risks cardiovascular events and patient survival.

SP25. The Association between Obesity and Migraine: Does This Exist?

PURPOSE: Migraine headaches are a chronic disease for millions worldwide. Metabolic syndrome including obesity and hypertension are hypothesized to be linked to an increased prevalence of migraine and to an increased migraine attack frequency. The aim of this study was to evaluate the association between obesity, menopausal status and migraine characteristics. METHODS: In this retrospective chart review, data from medical records between July 2013-July 2022 of patients who presented with migraine headache at the plastic and reconstructive surgery department at The Ohio State University were reviewed. Demographic data, body mass index (BMI) and blood pressure were recorded. Migraine headache characteristics were extracted and the migraine headache index (MHI) was calculated. The MHI was calculated by multiplying frequency, duration and intensity of migraine headaches. Univariate linear regression models were used to evaluate the associations between measures of migraine, metabolic syndrome and menopausal status. RESULTS: A total of 211 patients with migraine headaches were identified. Seventy-eight percent were female and 22% were male, with an average age of 44.6±12.8 years (average ± SD). Center for Disease Control and Prevention (CDC) classification of BMI was used. Higher MHI and number of headaches per month were significantly associated with class 3 obesity (BMI >40, p<0.01), but not with other BMI classes (p>0.05). Intensity and duration of headaches were not associated with BMI, respectively (p>0.05). Postmenopausal status was associated with a significantly lower number of migraines per month (p=0.02). Hypertension was not associated with migraine characteristics (p>0.05). CONCLUSION: A higher BMI is associated with increased MHI and frequency of migraines, but not with the intensity and duration of headaches experienced. Furthermore, number of headaches decreased after menopause. As fat mass increases in obesity, aromatase expression and consequently estrogen levels are also elevated, which impacts migraine headaches. Moreover, higher BMI may also impact compression neuropathy. These findings provide new insights into the association between obesity and migraine headaches. Future multicenter studies are needed to explore these associations in a larger group of patients.

Surgical Outcome and Treatment Trends in 1289 Infants with Micrognathia: A Multicenter Cohort.

Studies of infants with micrognathia, especially Robin sequence, are limited by its rarity and both phenotypic and diagnostic variability. Most knowledge of this condition is sourced from small, single-institution samples. This is a cross-sectional study including infants with micrognathia admitted to 38 Children's Hospital Neonatal Consortium centers from 2010 through 2020. Predictor variables included demographic data, birth characteristics, cleft, and syndrome status. Outcome variables included length of stay, death, feeding or respiratory support, and secondary airway operations. A total of 1289 infants with micrognathia had surgery to correct upper airway obstruction. Mean age and weight at operation were 34.8 ± 1.8 weeks and 3515.4 ± 42 g, respectively. A syndromic diagnosis was made in 150 (11.6%) patients, with Stickler (5.4%) and Treacher Collins (2.2%) syndromes being the most common. Operations included mandibular distraction osteogenesis (MDO) in 66.3%, tracheostomy in 25.4%, and tongue-lip adhesion (TLA) in 8.3%. Patients receiving a tracheostomy had lower birthweight, head circumference, gestational age, and Apgar scores. Patients undergoing MDO were less likely to need a second airway operation compared with patients undergoing TLA (3.5% versus 17.8%; P < 0.001). The proportion of infants feeding exclusively orally at hospital discharge differed significantly, from most to least: MDO, TLA, and tracheostomy. Hospital length of stay was not statistically different for patients who had MDO or TLA, but was longer for those with primary tracheostomy. The mortality rate was low for all operations (0.5%). In this surgical patient cohort, MDO was associated with shorter hospital stay, improved oral feeding, and lower rates of secondary airway operations. Prospective multicenter studies are necessary to support these conclusions. Risk, III.

The status of low anterior resection syndrome: data from a single-center in China

AimThe incidence and risk factors of low anterior resection syndrome (LARS) largely variate in different studies. In addition, there is lack of study on how patients evaluate the therapeutic effect of LARS. This single-center retrospective study aims to investigate the status of LARS in Chinese patients undergoing laparoscopic low anterior resection (LAR).MethodsConsequent patients undergoing laparoscopic LAR and free from disease recurrence from January 2015 to May 2021 were issued with both LARS questionnaire and satisfaction survey. Related data were collected and analyzed.ResultsBoth LARS questionnaires and self-made satisfaction survey were received from 261 eligible patients. The overall incidence of LARS was 47.1% (minor in 19.5%, major in 27.6%), decreased with the passage of postoperative time (64.7% within 12 months, and 41.7% within 12–36 months), and became stable 36 months later (39.7%). The most common symptoms were defecation clustering (n = 107/261, 41.0%) and defecation urgency (n = 101/261, 38.7%). According to the multivariable regression analysis, risk factors of major LARS were: 1 year increase in age (OR 1.035, 95% CI 1.004–1.068), protective stoma (OR 2.656, 95% CI 1.233–5.724) and T3 − 4 stage (OR 2.449, 95% CI 1.137–5.273). Most patients complained defecation disorder (87.3%) to doctors and 84.5% got suggestions or treatments for it. However, only 36.8% patients thought the treatments worked for them.ConclusionsLARS frequently occurs after laparoscopic LAR, while the therapeutic effect is not satisfying. Elder, advanced T-stage and protective stoma were risk factors for postoperative major LARS.

AP-452681-2 6 MONTH FOLLOW-UP OF A SUCCESSFUL FLUOROLESS PEDIATRIC GANGLIONATED PLEXI ABLATION

Cardioneuroablation (CNA) has been shown to treat vagally mediated bradyarrhythmias and vasovagal syncope. In this case, an 8-year-old female with Down’s Syndrome, duodenal atresia, and intermittent nocturnal AV block status post pacemaker without significant cardiopathy underwent successful ganglionated plexi ablation. To discuss the novel use of CNA in pediatric patients for symptomatic vasovagal syncope which can significantly reduce the volume of pacemakers implanted and obviate the need for subsequent lifelong generator replacements and lead revisions. CNA and GP locations were described and reviewed by Garcia et al for cardioinhibitory syncope treatment and prevention.1 Guidelines followed for CNA were well defined by Pachon2 and Aksu3. Localized assessments were performed at areas of complex fractionated signals at main ganglionated plexi (GP) locations. GP/cardiac insertion points are defined through high frequency (HF) EGM analysis with fractionation mapping software (NAVX, Abbott), as 3-5 deflections within the atrial cardiac cycle. Higher frequency signals were localized during mapping and correlated with traditional EGM analysis of 30-500Hz. All catheter positions were visualized with vascular ultrasound and NAVX 3-D mapping. Pacing the vagus nerve 50 Hz/50 microseconds provoked sinus slowing on the left and AV block on the right (figure 2). Fluoroscopy was not utilized. Standard RF targets were set at 60°C with maximum power of 50W. RF lesions were applied to previously defined GP1-4, targeting areas of HF signals4 for a maximum of 60 seconds. HR increase was noted with RF at GP1(18%), and this persisted throughout the case. Wenckebach cycle length change was 13%. Post ablation, HR remained unchanged during stimulation of bilateral vagal nerves. Additionally, there was no change in HR with atropine administration. At 6 month follow up, device check shows 0% pacing. Holter monitor demonstrated transient Wenckebach during sleep. Successful fluoroless GP ablation was performed for recurrent severe cardioinhibitory bradycardia. 6 month follow-up device check 0% pacing burden re-demonstrates sustained success of CNA. Future plans include another 6 months of monitoring followed by pacemaker deactivation and extraction discussion.

PO-04-079 FIRING EXTRA CHAMBERS: COR TRIATRIATUM SINISTER WITH ATRIAL FIBRILLATION

Cor triatriatum sinister (CTS) is a rare congenital defect in which the left atrium is divided into two chambers by a fenestrated fibromuscular septum. It is found in less than 0.1% of clinically diagnosed cardiomyopathy and 0.4% of autopsies of congenital heart disease patients. Dyspnea was reported as the most common symptom and atrial fibrillation (AF) was described in 30% of the published cases of CTS. We report a young patient with CTS who had recurrent paroxysmal atrial fibrillation (PAF) that underwent standard radiofrequency (RF) pulmonary vein isolation (PVI). 1. To recognize the relation of a rare congenital anomaly to AF 2. Effectiveness of standard PVI in CTS with AF NA A 39-year-old male was referred for symptomatic PAF with CHAD2VASc score of 3. Medical history was significant for CTS, tachybrady syndrome status post leadless pacemaker, diabetes, hypertension, HFpEF, and sleep apnea on CPAP. Pertinent medications were rivaroxaban, diltiazem and metoprolol. AF burden could not be determined. Echocardiogram revealed LA volume of 119 ml, CTS with volume index 52ml/m2 with an opening of 0.8 cm2 and moderate mitral regurgitation with valve area 2.9cm2, PHT 77 ms. Right heart cath showed PAP 50/30 mmHg, PCWP 30 mmHg and PVR 0.8 Woods unit. Cardiac index was 3.5L/min/m2. Despite optimization of rate control therapy and DC cardioversion, the patient had recurrent debilitating AF and decided to undergo RF AF ablation. Intracardiac echo showed the membrane to be attached to the posterolateral ridge laterally and to the interatrial septum medially. Voltage mapping revealed a healthy posterior wall. PVI was achieved successfully with first pass ablation. Patient maintained sinus rhythm at the 3 months follow up. CTS was first described in 1868 by Church. Development of AF from CTS in adults can be related to calcification of the membrane fenestrations leading to mitral stenosis and eventual development of mitral regurgitation with aging.

Investigating the genetic contribution in febrile infection-related epilepsy syndrome and refractory status epilepticus.

Febrile infection-related epilepsy syndrome (FIRES) is a severe childhood epilepsy with refractory status epilepticus after a typically mild febrile infection. The etiology of FIRES is largely unknown, and outcomes in most individuals with FIRES are poor. Here, we reviewed the current state-of-the art genetic testing strategies in individuals with FIRES. We performed a systematic computational analysis to identify individuals with FIRES and characterize the clinical landscape using the Electronic Medical Records (EMR). Among 25 individuals with a confirmed FIRES diagnosis over the last decade, we performed a comprehensive review of genetic testing and other diagnostic testing. Management included use of steroids and intravenous immunoglobulin (IVIG) in most individuals, with an increased use of immunomodulatory agents, including IVIG, plasma exchange (PLEX) and immunosuppressants such as cytokine inhibitors, and the ketogenic diet after 2014. Genetic testing was performed on a clinical basis in almost all individuals and was non-diagnostic in all patients. We compared FIRES with both status epilepticus (SE) and refractory status epilepticus (RSE) as a broader comparison cohort and identified genetic causes in 36% of patients with RSE. The difference in genetic signatures between FIRES and RSE suggest distinct underlying etiologies. In summary, despite the absence of any identifiable etiologies in FIRES, we performed an unbiased analysis of the clinical landscape, identifying a heterogeneous range of treatment strategies and characterized real-world clinical practice. FIRES remains one of the most enigmatic conditions in child neurology without any known etiologies to date despite significant efforts in the field, suggesting a clear need for further studies and novel diagnostic and treatment approaches.

Total urinary polyphenol excretion: a biomarker of an anti-inflammatory diet and metabolic syndrome status

BackgroundChronic inflammation is associated with noncommunicable diseases, including obesity, metabolic syndrome (MetS), and CVDs. The Mediterranean diet has been shown to have strong anti-inflammatory effects, attributed in part to the polyphenol richness of many of its components. ObjectivesThis study aimed to assess the value of polyphenols as a urinary biomarker of an anti-inflammatory diet and their influence on MetS status. MethodsA longitudinal analysis was performed in Spain considering 543 participants with high CVD risk in a PREDIMED study. Approximately 52% of the participants were women and 48% were men with a mean age of 67.5 (5.9) y. Total polyphenol excretion (TPE) in urine was determined at baseline and 5 y of intervention using a validated Folin–Ciocalteu spectrophotometric method, and the dietary inflammatory index (DII) was calculated from a validated 137-item food-frequency questionnaire. Three categories were built according to tertiles of change in the DII score. Multivariable linear regression analyses were performed to assess the association of changes in TPE with changes in the DII scores and with MetS status at 5 y. ResultsTertiles 2 and 3 compared with tertile 1 presented a lower anti-inflammatory potential of the diet and were inversely associated with TPE in women [−0.30 mg gallic acid equivalent (GAE)/g creatinine; 95% CI: −0.46, −0.15; P value = 0.006 and −0.29 mg GAE/g creatinine; 95% CI: −0.43, −0.15; P value = 0.005], respectively. The mean changes in TPE were 7.9 (56.1) mg GAE/g creatinine in women and 7.7 (48.2) mg GAE/g creatinine in men. In addition, TPE was inversely associated with changes in MetS status [−0.06 (−0.09; −0.02), P value = 0.009] in both men and women. ConclusionsUrinary polyphenols may be a potential biomarker of anti-inflammatory diet consumption in women and are prospectively associated with improvement in MetS.