Improvement In Subjective Symptoms Research Articles

Change in self-reported cognitive symptoms after mild traumatic brain injury is associated with changes in emotional and somatic symptoms and not changes in cognitive performance.

To investigate (a) whether self-reported cognitive symptoms after mild traumatic brain injury (MTBI) are associated with cognitive test performances, and (b) whether improvement in self-reported symptoms from 2 weeks to 3 months after MTBI is associated with improvement in cognitive test performances. Patients with MTBI (n = 135), aged 16-59, who initially presented to the emergency department, completed the Rivermead Post Concussion Symptoms Questionnaire (RPQ), the Brief Symptom Inventory 18, and cognitive tests (i.e., Controlled Oral Word Association, Coding, Rey Auditory Verbal Learning, and Trail Making test) at 2 weeks and 3 months after MTBI. Using Spearman's rank correlations (ρ), associations were examined between self-report measures and cognitive test performances at each time point and between change scores (i.e., 3-month score minus 2-week score) on each outcome. At 3 months, 27% reported cognitive symptoms to some extent. At both assessments, greater severity of RPQ cognitive symptoms was very weakly associated with worse cognitive test performances (2-week ρ range = -0.19 to -0.01; 3-month ρ range = -0.20 to -0.10). RPQ cognitive symptoms were, however, strongly related to greater somatic and emotional symptoms. Change in self-reported cognitive symptoms from 2 weeks to 3 months was not associated with change in cognitive test performance. In contrast, change in self-reported cognitive symptoms was strongly associated with change in emotional (ρ = 0.58) and somatic symptoms (ρ = 0.57). These findings indicate that improvements in subjective cognitive symptoms after MTBI co-occur with improvements on other subjective metrics, but are not related to improvements in objectively measured cognitive functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Current Treatment Options for Patulous Eustachian Tube: A Review of the Literature.

Patulous Eustachian tube (PET) is a clinical condition that is associated with troublesome aural symptoms and is difficult to be treated successfully. The purpose of this review is to examine the published literature regarding the therapeutic value of the current treatment options for PET. We searched Web of Science, PubMed and Medline from 1999 to 2019. The search focused on papers concerning the clinical evaluation of treatment methods in PET patients. Statistical techniques were not used. Prospective and retrospective case series were the types of trials available for review. We included 28 articles that evaluated the efficacy of various conservative and surgical therapeutic options. The recovery rates ranged from 50% to 100%. In most studies the assessment of efficacy was based on the subjective improvement of patient symptoms as there is no validated outcome tool available. No severe adverse events were observed in any study. On the basis of the available literature, it seems that conservative treatments can be considered as a primary therapeutic option for PET. Concerning the surgical interventions they seem to be a safe and valuable solution in patients with refractory disease. Finally, given the low level of evidence, prospective case-control studies with long follow-up and robust setting looking into the therapeutic approach of PET are required. The need for establishment of standard criteria of PET recovery should be underlined.

In situ decompression vs conservative treatment for mild ulnar neuropathy at the elbow.

The best treatment strategy for mild ulnar neuropathy at the elbow (UNE) is not known, due to lack of trials comparing surgery vs conservative treatment. We recruited patients with clinical symptoms and signs of mild UNE and an electrophysiologically or sonographically confirmed diagnosis. Patients were randomly allocated to either in situ decompression or conservative treatment. The primary outcome was the proportion of patients with subjective symptom improvement at short-term (3 months) and long-term (6-12 months) follow-up. One hundred seventeen patients were included: 56 and 61 patients were allocated to surgery and conservative treatment, respectively. A larger proportion of surgically treated patients showed improvement at short-term follow-up (85% vs 50%; odds ratio, 5.6; P < .001), but no differences were observed at long-term follow-up. In situ decompression for mild UNE may result in faster relief of symptoms when compared with conservative treatment, but at long-term follow-up no differences were observed.

Therapeutic Suggestion in Postoperative Pain Control: A Randomized Controlled Trial.

There is conflicting research on the effect of therapeutic suggestion in the perioperative period. This study systematically compared subjective and objective measures of postoperative pain, nausea and vomiting, urinary and bowel function, and global perception of symptomatic improvement between participants receiving perioperative therapeutic suggestion versus routine perioperative care during minimally invasive pelvic reconstructive surgery. This was a single-blinded, randomized controlled trial of participants undergoing vaginal hysterectomy with minimally invasive sacrocolpopexy and concomitant prolapse repairs. The intervention group received perioperative therapeutic suggestion, whereas the control group did not. Primary outcomes included postoperative pain scores and analgesic use. Secondary outcomes included a postoperative nausea and vomiting scale, the Pelvic Floor Distress Inventory Questionnaire-Short Form 20, the Patient Global Impression of Improvement scale, and time to return of bowel and bladder function. Sixteen participants were randomized to each group. Final analysis included 15 intervention and 14 control participants. Overall measures of postoperative pain and analgesic use were low across all participants without a significant difference between intervention and control groups (opioid: 52.5; interquartile range [IQR], 25.5-58.9 vs 66 IQR, 7.3-125.8; morphine milligram equivalents; P = 0.64; acetaminophen: 2225 mg; IQR, 500-2600 mg vs 2800 mg; IQR, 650-4775 mg; P = 0.38). There were no statistically significant differences in secondary outcomes of urinary symptoms, bowel function, and subjective improvement of prolapse symptoms. No differences in postoperative pain, analgesic use, return of bowel and bladder function, or pelvic organ prolapse symptoms were noted in participants receiving perioperative therapeutic suggestion versus routine perioperative care.

Real-life Management Strategy of COVID-19 Patients in Bangladesh with No Death: An Observational and Cohort Study.

ABSTRACTBackgroundCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared as pandemic by World Health Organization (WHO) with increasing morbidity (more than 4.6 million patients) and mortality (300,000 deaths). The world-wide target of management COVID-19 is to reduce complications with available management options; this become highly variable from country to country and even within different regions of the same country.Aim and objectiveThis observational prospective study represents a single center study in which all patients in this cohort received almost similar medicines and care.Materials and methodsAll patients in this cohort (N: 32) were positive for SARS-CoV-2 by polymerase chain reaction (PCR) with variable presenting symptoms. The management strategy included Standard of Care (SoC) and administration of hydroxychloroquine and doxycycline. Out of 32 patients, 9 patients also received favipiravir. All patients were followed until they were discharged after negativity of SARS-CoV-2 confirmed by PCR on two consecutive occasions taken within 2 days.ResultsNo death has been recorded in this cohort of 32 patients within the study period. The average hospital staying duration was 13.9 days with a range of 8–21 days. All patients were discharged with improvement of subjective symptoms and SARS-CoV-2 negativity. The vital signs (pulse, blood pressure) as well as and levels of electrolyte and blood counts were within normal and acceptable ranges at the time of discharge.ConclusionThe study presented here provide and evidence of a real-life situation of management of limited numbers of COVID-19 patients at a tertiary center of Bangladesh. This study inspires optimism that proper diagnosis, establishment of effective inclusion and exclusion criteria, ensuring application of proper SoC with drugs available in Bangladesh may be a practical option for management of COVID-19 in the country.How to cite this articleHuq AKMF, Rahman MF, Islam MA, et al. Real-life Management Strategy of COVID-19 Patients in Bangladesh with No Death: An Observational and Cohort Study. Euroasian J Hepato-Gastroenterol 2020;10(1):31–35.

In Vivo Visualization of Rainbow Glare and Treatment With Undersurface Flap Phototherapeutic Keratectomy

To analyze a case of unilateral rainbow glare that required repeated undersurface photoablation using an excimer laser. A 31-year-old man with bilateral myopia of 6.50 diopters treated with femtosecond laser-assisted in situ keratomileusis immediately experienced a 2-year life-incapacitating rainbow glare exclusively in the right eye. The laser settings were similar for both eyes, but a subtle raster pattern was noticed intraoperatively in the right eye. Postoperative uncorrected distance visual acuity (UDVA) was 20/12.5, but with important subjective visual quality impairment in the right eye. Slit-lamp examination and investigations were unremarkable except for hyperreflective dots arranged in a regular grating pattern on confocal microscopy in the right eye. A 10-µm undersurface photoablation was performed with immediate but incomplete improvement of both subjective symptoms and objective reduction of the grating pattern on confocal microscopy. After 12 months, the patient asked for additional treatment and another 10-µm undersurface photoablation was performed, this time with resolution of the symptoms. At last follow-up, 6 months after the second revision, UDVA was maintained with total absence of rainbow glare and no hypermetropic shift was observed. Rainbow glare is typically a benign and often spontaneously resolving condition that can rarely cause dramatic life impairment. This case reinforces the hypothesis that it is caused by diffraction created by the raster spot pattern of the femtosecond laser, which can be followed by confocal microscopy. It also further proves that undersur-face photoablation is an efficient, repeatable, and safe treatment for rainbow glare, and should include a thickness of at least 16 to 20 µm. [J Refract Surg. 2020;36(6):400-404.].

A randomised trial comparing the subjective outcomes following septoplasty with or without inferior turbinoplasty

AimsThe surgical management of contralateral inferior turbinate hypertrophy in patients with deviated nasal septum is controversial. In this randomised clinical trial, we aimed to investigate the subjective improvement of nasal symptoms postoperatively in patients undergoing septoplasty with or without inferior turbinoplasty. Material and methodsOne hundred and thirty-seven patients with nasal obstruction, who had unilateral septal deviation and compensatory contralateral inferior turbinate enlargement, were randomised into either septoplasty alone arm (n=66) or septoplasty combined with turbinoplasty arm (n=71). Preoperative symptom scores and the subjective perception of the nasal obstruction were compared between two groups of the study using Nasal Obstruction Symptom Evaluation Scale (NOSE) and Visual analog scale (VAS) respectively. The measurements were repeated 6 months after surgery as well as at 1, 2, and 4 years postoperatively. ResultsWith regard to the findings obtained from both scales, both interventions successfully relieved the patients’ complaints of nasal obstruction at almost all postoperative visits when compared with the baseline measurements (P˂0.005 for most comparisons). However, the relief of nasal obstruction was more pronounced in patients undergoing combined intervention at all postoperative visits, except at the 1st follow-up session (P˂0.005). Nasal symptoms of septoplasty alone group began to deteriorate over the period between month 24 and month 48. In contrast, patients undergoing the combined surgery steadily showed symptomatic improvement over the whole period of study. ConclusionsA turbinate reduction surgery should be conducted along with septoplasty to achieve better results in cases suffering from deviated nasal septum with concomitant hypertrophied inferior turbinate.

SAT-204 ACTH-Producing Pheochromocytoma, a Challenging Disease to Diagnose and Manage

Background: ACTH-producing pheochromocytomas (APP) are a rare cause of ectopic Cushing’s syndrome (CS), representing <6% of these cases. No guidelines exist on the management of these tumors. Clinical case: A 41-year-old woman presented to the ED with a 6-month history of newly-diagnosed T2DM and difficult-to-control hypertension. Three weeks prior to admission she developed fatigue, dyspnea on exertion, and generalized weakness particularly severe in the lower extremities (LE) limiting her ability to ambulate. She denied headaches, palpitations and diaphoresis. Initial vital signs included HR 111 beats/min and BP 217/112 mmHg. On physical exam she had classic findings of CS with severe LE weakness. Laboratory testing was consistent with ACTH-dependent CS (ACTH 463 pg/mL [0-45], cortisol 70.8 mcg/dL [3-23], potassium 2.7 mMol/L [3.1-5.1]). She failed both the low dose (1 mg) and high dose (8 mg) dexamethasone suppression tests. MRI of the pituitary gland ruled out a pituitary lesion. IPSS was not deemed necessary by Neurosurgery. CT abdomen showed a 4.2 cm right adrenal lesion and bilateral adrenal hyperplasia. This prompted workup for pheochromocytoma that revealed elevated plasma metanephrines (4.1 nMol/L, [<0.5]) and 24hr urine metanephrines (5329 mcg/day, [182-739]). A diagnosis of APP was entertained. Doxazosin 1 mg BID was added to her other antihypertensives with improvement in blood pressure. Ketoconazole 200 mg TID was started as a bridge for surgery. Patient underwent right unilateral adrenalectomy one month after initial presentation. ACTH and cortisol levels before surgery were 534 pg/mL and 87 mcg/dL, respectively, suggesting that ketoconazole was not effective. Both ACTH and cortisol levels decreased to 26 pg/mL and 14.4 mcg/dL, respectively, immediately after surgery. There was prompt subjective symptomatic improvement, including mild recovery of LE strength. Her blood pressure normalized and only spironolactone was continued. She was started on a prednisone taper. Pathology revealed a 4.2 pheochromocytoma and diffuse adrenocortical hyperplasia. Tumor cells stained positive for ACTH on immunohistochemistry. On follow up visit 2 months after surgery patient was feeling well and ambulating without difficulty. Labs were remarkable for normal plasma fractionated metanephrines, and A1c 5.1% on metformin alone (down from 4 medications on initial presentation). Conclusion: Diagnosis and management of APP can be challenging. Alpha-blockers should be started promptly. Definitive treatment with unilateral adrenalectomy is curative and has been recommended as the preferred approach.1 Ketoconazole may be used as bridge therapy for surgery, though some studies suggest its efficacy might be lower in ectopic CS.2 Response to other pharmacologic agents is largely unknown.

Subjective and Objective Effectiveness of Eustachian Tube Balloon Dilatation for Patients With Eustachian Tube Dysfunction-Evaluation in a Pressure Chamber.

The Eustachian tube plays a crucial role in pressure equalization between the middle ear and ambient pressure for fast and large pressure differences. In patients with chronic Eustachian tube dysfunction, Eustachian tube balloon dilatation is increasingly used as surgical therapy. Subjectively, many patients report an improvement of the symptoms postoperatively. Hence, there is a need to objectively measure this effect. The objectivity of Eustachian tube balloon dilatation was evaluated using a precise method of measuring Eustachian tube function. In a hypo/hyperbaric pressure chamber, 23 ears in 13 patients were exposed to a standardized profile of compression and decompression before Eustachian tube balloon dilatation and 4 weeks afterwards. Standardized parameters of Eustachian tube function were determined and statistically compared before and 4 weeks after intervention. In addition, an Eustachian Tube Dysfunction Questionnaire-7 (ETDQ7) questionnaire was completed beforehand and 4 weeks postoperatively to determine subjective surgical success. The results from the ETDQ7 questionnaire showed a significant improvement in symptoms after Eustachian tube balloon dilatation (p = 0.0002). Objective measurements results showed a significant reduction of the Eustachian tube opening pressure during pressure decrease 4 weeks after intervention (p = 0.0012). Eustachian tube balloon dilatation significantly reduced Eustachian tube opening pressure, in addition to subjective improvement of symptoms determined by ETDQ7.

Optimizing Quality of Life for Patients with Breast Cancer-Related Lymphedema: A Prospective Study Combining DIEP Flap Breast Reconstruction and Lymphedema Surgery.

Patients with breast cancer-related lymphedema can be treated with a simultaneous deep inferior epigastric perforator (DIEP) flap, vascularized inguinal lymph node transfer, and lymphovenous anastomosis for aesthetic breast reconstruction and lymphedema in one operation. The authors performed a comparison of prospectively followed patients who underwent free flap breast reconstruction with vascularized inguinal lymph node transfer and anastomosis to a retrospective cohort of patients who underwent free flap breast reconstruction with vascularized inguinal lymph node transfer alone. Thirty-three patients underwent DIEP flap reconstruction with vascularized inguinal lymph node transfer and lymphovenous anastomosis, and 21 received a free flap with lymph node transfer alone. There were no significant differences in demographics, adjuvant chemotherapy, or radiation therapy. The average number of nodes removed was also equivalent (21.2 versus 21.4 nodes). Two anastomoses per patient, on average, were performed (range, one to four) in the combined cohort, and all patients (100 percent) reported a subjective improvement in symptoms, compared with 81.0 percent of patients undergoing only lymph node transfer (p = 0.019). Perometer measurements demonstrated a significant reduction between the groups at early time points [3 months, 40.7 percent versus 20.0 percent (p = 0.037); 6 months, 57.0 percent versus 44.5 percent (p = 0.043)]; however, the difference was not statistically significant at 12 months (60.4 percent versus 57.8 percent; p = 0.43). This is the first prospective study demonstrating the safety and efficacy of a combined DIEP flap with vascularized inguinal lymph node transfer and lymphovenous anastomosis, which may be superior to lymph node transfer alone. Therapeutic, III.

MP31-05 IS THE 50% IMPROVEMENT THRESHOLD ADEQUATE FOR PROGRESSION TO IMPLANTATION IN SACRAL NEUROMODULATION?

INTRODUCTION AND OBJECTIVE: A >50% subjective improvement in urinary symptoms during sacral nerve stimulation testing (SNSt) is currently used as indication for progression to stage two implantation (St2i). While approximately 66-75% of patients will have successful SNSt and proceed to St2i, some deterioration in efficacy over time has been reported. It is unclear if this is related to the initial degree of improvement. We sought to determine if >50% improvement after SNSt is sufficient to predict long-term success. METHODS: The records of 213 patients who underwent SNSt for overactive bladder (OAB). Subjects were divided into those who reported 50-75% improvement and >75% improvement after SNSt who went on to St2i. Differences in clinical variables including patient-reported outcome measures, diary and pad test information, and urodynamic characteristics were compared between groups. Cox proportional hazard regression was performed to assess for associations between these variables, reported improvement after SNSt, and long-term success with SNS after St2i. RESULTS: Of 213 OAB patients who underwent St1i, 86 (40.3%) reported 50-75% improvement and 76 (88.3%) of those progressed to St2i (group 1) whereas 68 patients (31.9%) reported >75% and 59 (86.8%) of those moved to St2i (group 2). Baseline characteristics (comorbidities, symptom scores, bladder diaries, pad usage and urodynamic parameters) were not significantly different between groups except that neuropathy was more prevalent in group 1 (48% vs 27%, p=0.02). After SNSt, improvements in symptom scores and diary/pad usage were not significantly different between groups apart from a greater improvement in AUASS bother score in group 2 (5.4 (n= 5) vs. 1.6 (n=5), p=0.01). After St2, group 2 patients were more likely to report a >75% improvement (71.2% vs 34.2%, p<0.01). With a mean follow-up of 46 months, 52/76 group 1 patients and 44/62 group 2 patients still had a functioning device providing symptomatic benefit with no significant difference found between groups on regression (chi2=0.1, p=0.75). CONCLUSIONS: We found no significant differences in the majority of baseline characteristics and clinical data after SNSt between patients with a 50-75% improvement and those with >75% improvement. Furthermore, there was no difference between groups in long-term device functionality. These findings suggest a >50% improvement threshold is adequate for progression to St2i. Source of Funding: None

Score-based improvement of the indication for surgical treatment ofthyroid lesions.

The prevalence of focal lesions in the thyroid is high in Germany. In 2018 about 70 000 thyroid surgeries were performed, although the malignancy rate of such findings is low. For this reason it is important to conduct an adequate selection of patients for whom surgery is indicated. The aim of our work was to validate the preoperative indication for surgery of thyroid lesions based on an independent, self-developed clinical score. The patient data were evaluated retrospectively over the period 2013 to 2014. A prerequisite for inclusion was that the patients had carried out their complete treatment in domo. The multiparametic score was determined retrospectively and ranges from 3 to 15. The subjective improvement of symptoms (self-disclosure > 6 months postoperatively) and the presence of malignant histology were evaluated as positive outcome parameters. From a collective of 180 patients, 36 patients could be included, in whom all score-relevant parameters had been surveyed. The score distribution was 10 % score 3, 12.5 % score 4, 25 % score 5, 25 % score 6, 12.5 % score 7, 7.5 % score 8, 5 % score 9 and 2.5 % score 10. Using ROC analysis shows an AUC of 0.903, which is a very good differentiation. With a CUT-off score of 7 or higher, 86 % of patients have benefited from surgery. Our score with the parameters clinical complaints, sonographically defined size of the thyroid and the cytological result of a fine needle biopsy can lead to an improvement of the indication for surgical treatment of thyroid nodules.

Improvement in Subjective Symptoms and Tolerability in Response to Nintedanib Treatment in Elderly Patients with Idiopathic Pulmonary Fibrosis.

The efficacy of nintedanib treatment in patients with idiopathic pulmonary fibrosis (IPF) was demonstrated in phase III trials. However, there is limited data on the significance of nintedanib in elderly patients aged ≥75 years. We have retrospectively evaluated 54 newly nintedanib-treated patients including 32 elderly individuals. Potential changes in modified medical research council (mMRC) grade and COPD (chronic obstructive pulmonary disease) assessment test (CAT) score, as well as in forced vital capacity (FVC) were obtained 6 months before, at the time of, and 6 and 12 months after initiation of nintedanib treatment. Significant differences were observed in CAT scores between 6 months before treatment and baseline (p < 0.001), and between baseline and 6 months (p < 0.001) and 12 months (p < 0.001) after treatment. If subjective improvement is defined as an improvement in mMRC grade or CAT score by 1 or 3 points, respectively, 25 patients (46.3%) have significantly improved after 6 months of treatment. Out of these, all have improved in CAT score. The tolerability of nintedanib was similar in elderly and younger patients. These findings suggest that CAT scores could be useful in the subjective assessment during nintedanib treatment, and that nintedanib is safe and efficient for the treatment of the elderly population.

LASER Haemorroidectomy for 2nd and 3rd Degree Piles

Abstract Background: According to the vascular theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid LASER procedure (He-LP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation. Aim of Study: The aim of our study was to assess the outcome of hemorrhoidal dearterialisation by a laser energy device. Patients and Methods: From November 2018 to November 2019, 51 patients with second-or third-degree hemorrhoids were studied. The aim was a decrease in the bleeding rate and decrease post-operative complications, reduction in pain and prolapse, resolution of symptoms, and degree of patient's perception of improvement. The rate and degree of symptoms was evaluated with a four-point verbal rating scale. The rate of subjective symptomatic improvement was also assessed with the Patient Global Improvement (PGI) Scale. Results: Mean bleeding and pain scores at baseline were 2 and 0.57. All the patients were discharged on the day of surgery. Post-operative complications were bleeding and external hemorrhoidal thrombosis. Mean bleeding and pain scores at 1 and 3 months were reduced. Conclusions: LASER procedure was effective in improv-ing bleeding and pain symptoms in patients with grade II and III piles.

Abstract No. 656 Anticoagulation following stent placement for nonthrombotic lower extremity venous disease

To compare outcomes between low- and high-dose anticoagulation regimens following stent placement for nonthrombotic lower extremity venous disease. Fifty-two consecutive patients (88.5% female, mean age 44 years) who underwent stent placement for nonthrombotic lower extremity venous disease between 2002-2016 were retrospectively identified. Patients were divided into two cohorts: those who received ≤2 weeks of postprocedural prophylactic enoxaparin or no anticoagulation (low-dose), and those who received ≥2 weeks of postprocedural therapeutic anticoagulation with enoxaparin, warfarin, and/or rivaroxaban (high-dose). Baseline demographic and clinical characteristics were compared between the two groups using Student’s t-tests and χ2 tests. Outcomes were assessed through comparison of complication rates, reintervention rates, and rates of patient-reported symptomatic improvement using χ2 tests and Kaplan-Meier methods. The low- and high-dose groups did not differ significantly on sex, race, ethnicity, age, procedure year, number of stents placed, stent brand, stent diameter, stented vein, antiplatelet therapy or follow-up time. There were no thrombotic complications (defined as diagnosis of a deep vein thrombosis anytime following stent placement) in either group. There were five minor bleeding complications (e.g., heavy menses or access site hematoma) in the high-dose group and zero bleeding complications in the low-dose group (P = 0.073). One patient in the low-dose group received reintervention versus two patients in the high-dose group (P = 0.61). There were no statistically significant differences in subjective symptom improvement. In this retrospective cohort, low-dose and high-dose anticoagulation regimens following lower extremity stent placement for nonthrombotic venous occlusions produced equivalent outcomes in terms of complication rates, reintervention rates, and symptomatic improvement. This suggests that short-term prophylactic anticoagulation or no anticoagulation may be as safe and effective as therapeutic anticoagulation following venous stent placement for nonthrombotic stenosis.

Acquisition of Cabozantinib-Sensitive MET D1228N Mutation During Progression on Crizotinib in MET-Amplified Triple-Negative Breast Cancer

BackgroundTargeting of somatic MET mutations using crizotinib has led to strong clinical responses, most frequently in patients with lung cancer, raising the possibility of adopting similar treatment strategies in patients with MET alterations in other cancer types. Patient and MethodsWe describe a patient with advanced triple-negative breast cancer with a 30-fold amplification of MET. Next-generation sequencing of pre- and postprogression biopsies was performed to identify the resistance mechanism emerging after an initial exceptional response to crizotinib. The response of the resistance mutant to type I and II MET inhibitors was assessed in cultured cells. ResultsAfter progressing on crizotinib, a MET-D1228N mutation was detected, which is located in the crizotinib-binding region of the MET kinase domain. Experimental studies demonstrated that this mutation confers complete resistance to crizotinib yet retains cabozantinib sensitivity. Treatment of the patient with cabozantinib led to a subjective improvement in clinical symptoms, but the patient progressed after 7 weeks. ConclusionAlthough MET mutations are rare in breast cancer, these patients may experience substantial clinical benefit from crizotinib treatment. Nevertheless, drug resistance owing to on-target MET mutations will likely be frequently encountered and comprehensive mechanistic studies to assess sensitivity of these mutants to a series of potential second-line therapies may help guide subsequent treatment for these patients.

Which pelvic floor muscle functions are associated with improved subjective and objective symptoms after 8 weeks of surface electrical stimulation in women with stress urinary incontinence?

ObjectiveStress urinary incontinence (SUI) is defined as involuntary urine loss during effort, sneezing, or coughing. We investigated which pelvic floor muscle (PFM) functions (muscle strength, power, and endurance) are associated with improvement in subjective and objective symptoms after 8 weeks of surface electrical stimulation (SES) training. This study was performed to determine the effects of SES in the seated position on PFM functions and subjective and objective symptoms, and to identify predictors of improved subjective and objective symptoms after 8 weeks of SES training via secondary analysis of females with SUI. Study designThe study was performed between August 2018 and December 2018. Patients with SUI were randomized into an SES group (n = 17) and a control group (n = 17). Both groups were assessed pre-intervention and after 8 weeks of intervention. The outcome measures were PFM functions (strength, power, and endurance) as measured via perineometry, the score on the urogenital distress inventory-6 (UDI-6), and the ultra-short perineal pad test result. ResultsSignificant differences in all PFM functions, the UDI-6 score, and the pad weight were evident both between the groups (SES vs. control group) and within the groups (pre-SES vs. post-SES). On regression of factors predicting relative changes in subjective and objective symptoms, the relative change in PFM power accounted for 15 and 13 % of the variance in the UDI-6 score (P < 0.05) and pad weight (P < 0.05), respectively. ConclusionsSES in a seated position improved both subjective and objective symptoms in females with SUI. PFM power, the UDI-6 score, and the pad weight test result should be considered when developing intervention guidelines to improve the subjective and objective symptoms of females with SUI.

The antidiarrheal efficacy of a proprietary amino acid mixture (enterade) in neuroendocrine tumor (NET) patients: Updated data.

614 Background: Diarrhea is a common quality of life limiting symptom seen in neuroendocrine tumor patient. Diarrhea in these patients could be due to excessive serotonin production, secondary to post-operative short gut syndrome, steatorrhea from somatostatin analogs, bile acid colitis or intestinal bacterial overgrowth. In this study we summarize our single center experience with enterade. Methods: Medical records of all the NET patients treated with enterade for symptomatic diarrhea were retrospectively reviewed after appropriate IRB approval. Patients were treated at Markey cancer center between May 2017-June 2019. Results: Total 98 patients were offered enterade. enterade was instructed to be taken as one 8 Oz bottle BID for 1 week. Antidiarrheal efficacy data was available on 49 patients at the time of abstract submission. 37 (75%) patients had GEPNETs, 8 had bronchial NETs, 1 gynecological NET and 3 patients had unknown primary. 28 (57%) patients had history of prior bowel resection either for primary neuroendocrine tumor resection or debulking. 28 (57%) patients were on somatostatin analog at the time of initiation of enterade. 42 (85%) out of 49 patients reported subjective improvement in diarrheal symptoms. 27 (64%) out of these 42 responders reported at least 50 percent reduction in diarrhea frequency. Conclusions: 85% (42/49) neuroendocrine tumor patients reported improvement in diarrhea with enterade. 64% (27/42) reported more than 50% reduction in diarrhea frequency. A prospective Phase II study of enterade in neuroendocrine tumor patients with quality of life limiting diarrhea is currently being conducted (NCT03722511).

The Effect of Vocal Fold Steroid Injection via Cricothyroid Membrane in Patients with Vocal Polyp

Background and Objectives Vocal polyps are generally caused by phonotrauma such as vocal overuse, and the first line treatment is known as laryngeal microsurgery. The aim of the study is to evaluate the applicability and effectiveness of percutaneous steroid injection via cricothyroid membrane in patients with vocal polyp and to evaluate its advantages and limitations of the technique.Subjects and Method We included in this study 70 patients with vocal polyp managed by vocal fold steroid injection via the cricothyroid membrane from Jan 2008 to July 2018. We compared their medical records of laryngoscopy, stroboscopy, and multi-dimensional voice program analysis at pre and post treatment. Subjective voice improvement was evaluated using Voice Handicap Index-30 (VHI-30).Results Of the patients, 54.3 percent showed morphological improvement. In acoustic analysis, the pre-treatment mean values of jitter, shimmer, and NHR were 2.20±2.23, 5.09±3.24, 0.15±0.04, respectively. The post-treatment values were 1.54±1.28, 5.00±4.40, 0.13±0.04, respectively, and only jitter was statistically significant. For subjective symptom improvement, 32 (45.8%) patients showed better score on the post-treatment of VHI-30 compared to pretreatment. Ten patients experienced mild complications such as vocal fold atrophy and scar; however, no critical complications such as internal bleeding or dyspnea were reported.Conclusion According to our study, steroid injection is a safe and effective procedure for patients with vocal polyp. A vocal fold steroid injection via the cricothyroid membrane can be an alternative treatment option for those who are not able to undergo conventional laryngeal microscopic surgery.

Does REM sleep behavior disorder change in the progression of Parkinson’s disease?

Objectives/backgroundRapid eye movement (REM) Sleep Behavior Disorder (RBD) in Parkinson's disease (PD) may be associated with a malignant phenotype. Despite its prognostic value, little is known about the time course of RBD in PD. In this study, we aimed to ascertain whether or not RBD is a stable feature in PD. In this study, we prospectively evaluated clinical and neurophysiological features of RBD, including REM Sleep Without Atonia (RSWA), in PD patients with RBD at baseline and after three years then assessed whether the changes in measures of RSWA parallel the progression of PD. Patients/methodsIn sum, 22 (17M, mean age 64.0 ± 6.9 years) moderate-to-advanced PD patients (mean PD duration at baseline:7.6±4.8 years) with RBD, underwent a video-polysomnography (vPSG) recording and clinical and neuropsychological assessment at baseline and after three years. ResultsAt follow-up, the self-assessed frequency of RBD symptoms increased in six patients, decreased in six and remained stable in 10, while RSWA measures significantly increased in all subjects. At follow-up, patients showed worse H&Y stage (p = 0.02), higher dopaminergic doses (p = 0.05) and they performed significantly worse in phonetic and semantic fluency tests (p = 0.02; p = 0.04). Changes in RSWA correlated significantly with the severity in levodopa-induced dyskinesia (r = 0.61,p = 0.05) and motor fluctuation (r = 0.54,p = 0.03) scores, and with the worsening of executive functions (r = 0.78,p = 0.001) and visuo-spatial perception (r = −0.57,p = 0.04). ConclusionDespite the subjective improvement of RBD symptoms in one-fourth of PD patients, all RSWA measures increased significantly at follow-up, and their changes correlated with the clinical evolution of motor and non-motor symptoms. RBD is a long-lasting feature in PD and RSWA is a marker of the disease's progression.