Suspected Risk Factors Research Articles

Associations between meteorological factors and emergency department visits for unintentional falls during Ontario winters.

Unintentional falls are a leading cause of injury-related hospital visits among Canadians, especially seniors. While certain meteorological conditions are suspected risk factors for fall-related injuries, few studies have quantified these associations across a wider range of age groups and with population-based datasets. We applied a time-stratified case-crossover study design to characterize associations of highly-spatially-resolved meteorological factors and emergency department (ED) visits for falls, in Ontario, among those aged 5 years and older during the winter months (November to March) between 2011 and 2015. Conditional logistic models were used to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs) for these visits in relation to daily snowfall accumulation, including single-day lags of up to one week before the visit, and daily mean temperature on the day of the visit. Analyses were stratified by age and sex. We identified 761 853 fall-related ED visits. The odds for these visits was increased for most days up to a week after a snowfall of 0.2 cm or greater (OR = 1.05-1.08) compared to days with no snowfall. This association was strongest among adults aged 30 to 64 years (OR = 1.16-1.19). The OR for fall-related ED visits on cold days (less than -9.4 °C) was reduced by 0.05 relative to days with an average daily temperature of 3.0 °C or higher (OR = 0.95; 95% CI: 0.94, 0.96), and this pattern was evident across all ages. There were no substantive differences in the strength of this association by sex. Snowfall and warmer winter temperatures were associated with an increased risk of fall-related ED visits during Ontario winters. These findings are relevant for developing falls prevention strategies and ensuring timely treatment.

Spatially varying effects of measured confounding variables on disease risk

BackgroundThe presence of considerable spatial variability in incidence intensity suggests that risk factors are unevenly distributed in space and influence the geographical disease incidence distribution and pattern. As most human common diseases that challenge investigators are complex traits and as more factors associated with increased risk are discovered, statistical spatial models are needed that investigate geographical variability in the association between disease incidence and confounding variables and evaluate spatially varying effects on disease risk related to known or suspected risk factors. Information on geography that we focus on is geographical disease clusters of peak incidence and paucity of incidence.MethodsWe proposed and illustrated a statistical spatial model that incorporates information on known or hypothesized risk factors, previously detected geographical disease clusters of peak incidence and paucity of incidence, and their interactions as covariates into the framework of interaction regression models. The spatial scan statistic and the generalized map-based pattern recognition procedure that we recently developed were both considered for geographical disease cluster detection. The Freeman-Tukey transformation was applied to improve normality of distribution and approximately stabilize the variance in the model. We exemplified the proposed method by analyzing data on the spatial occurrence of sudden infant death syndrome (SIDS) with confounding variables of race and gender in North Carolina.ResultsThe analysis revealed the presence of spatial variability in the association between SIDS incidence and race. We differentiated spatial effects of race on SIDS incidence among previously detected geographical disease clusters of peak incidence and incidence paucity and areas outside the geographical disease clusters, determined by the spatial scan statistic and the generalized map-based pattern recognition procedure. Our analysis showed the absence of spatial association between SIDS incidence and gender.ConclusionThe application to the SIDS incidence data demonstrates the ability of our proposed model to estimate spatially varying associations between disease incidence and confounding variables and distinguish spatially related risk factors from spatially constant ones, providing valuable inference for targeted environmental and epidemiological surveillance and management, risk stratification, and thorough etiologic studies of disease.

Altered DNA Methylation in Patients With Youth Onset Type 2 Diabetes in the iCARE Cohort

Type 2 diabetes (T2D) incidence in children is on the rise. Early environmental exposures are suspected risk factors for youth-onset T2D. However, the underlying mechanism by which these exposures confer risk have not been explained. We hypothesize that early exposures alter DNA methylation (DNAm) patterns that play a key role in youth-onset T2D. This study examined DNAm patterns and potential biological pathways implicated in youth-onset T2D. We examined whole blood DNAm from 306 youths (ages 9-26; diagnosed before 18) from the iCARE cohort using the Illumina EPIC methylation array. DNAm changes associated with T2D were identified by comparing the DNAm profiles of children with (n=224) and without (n=82) T2D, matched for BMI and ethnicity, using linear regression. We identified 2,982 differentially methylated CpGs (adjusted p-value <0.05, effect size ≥1%), a subset of which were previously associated with T2D in adults (TXNIP: effect size –11%; ABCG1: 3%; SREBF1: 3%). In addition, we identified CpGs with roles in mitochondrial metabolic regulation (VWA8: –7%) and insulin-induced vasodilation (MPRIP: 7%). Our findings build the basis for future studies to identify pathways involved in youth-onset T2D, assess the utility of these signatures as biomarkers for screening and early detection, and identify protective environmental exposures. We would like to acknowledge the important contributions and guidance of the iCARE Participant Advisory Group and Data Access Committee in this work’s interpretation.

Update to post-acute sequelae of SARS-CoV-2 infection: Caring for the 'long-haulers'.

An estimated 10% of COVID-19 survivors continue to experience symptoms several weeks to months after the appearance of initial symptoms, a condition termed post-acute sequelae of SARS-CoV-2 infection (PASC). These patients, also called "long-haulers," most commonly report protracted symptoms of fatigue, cough, dyspnea, chest tightness, difficulty concentrating, arthralgia, olfactory dysfunction, and headache. While age, comorbid medical conditions, and COVID-19 severity are suspected risk factors for PASC, young and previously healthy individuals with mild COVID-19 are also at risk. Recognition of symptoms, evaluation, supportive treatment, and attention to medical comorbidities are the cornerstones of medical management.

Plantar Injuries in Runners: Is There an Association With Weekly Running Volume?

Running is an athletic activity that is increasingly gaining popularity. Despite its benefits, there are many suspected risk factors for running-related overuse injuries. The objective of this study is to describe injuries and clinical symptoms observed on the sole of the foot in runners, giving special attention to the weekly running volume. The literature presented in this narrative review is based on a non-systematic search of the Medline, Google Scholar, and ResearchGate databases and focuses on foot injuries (the full spectrum of the foot pathology from bones to tendons and plantar fascia, nerve, and joint disorders) in runners, which represents an important topic for both professional and recreational runners. The weekly running distance appeared to be one of the strongest predictors for future overuse injuries. Marathon training and average weekly running of over 20 km are possible predictive factors in the development of plantar foot injuries. The plantar medial aspect of the foot is the anatomic area of the foot that most frequently experiences pain, with numerous pathologic conditions. As a result, diagnosis is always a challenging task. The ability to obtain an accurate medical history and carefully perform a physical examination, together with good knowledge of the foot anatomy and kinesiology, are also proven to be key players in ensuring proper diagnosis.

Screening for Lung Cancer in Individuals Who Never Smoked: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report

Screening with low-dose computed tomography of high-risk individuals with a smoking history reduces lung cancer mortality. Current screening guidelines and eligibility criteria can miss more than 50% of lung cancers, and in some geographic areas, such as East Asia, a large proportion of the missed lung cancers are in never-smokers. Although randomized trials revealed the benefits of screening for people who smoke, these trials generally excluded never-smokers. Thus, the feasibility and effectiveness of lung cancer screening of individuals who never smoked are uncertain. Several known and suspected risk factors for lung cancers in never-smokers such as exposure to secondhand smoke, occupational carcinogens, radon, air pollution, and pulmonary diseases, such as chronic obstructive pulmonary disease and interstitial lung diseases, and intrinsic factors, such as age, are well noted. In this regard, knowledge of risk factors may make possible quantification and prediction of lung cancer risk in never smokers. It is worth considering if and how never smokers could be included in population-based screening programs. As the implementation of these programs is challenging in many countries owing to multiple factors and the epidemiologic differences by global regions, these issues will need to be evaluated in each country taking into account various factors, including accuracy of risk assessment and cost-effectiveness of screening in never smokers. This report aims to outline current knowledge on risk factors for lung cancer in never smokers to propose research strategies for this topic and initiate a broader discussion on lung cancer screening of never smokers. Similar considerations can be made in current and ex-smokers, which do not fulfill the current screening inclusion criteria, but otherwise are at increased risk. Although screening of never smokers may in the future be effectively conducted, current evidence to support widespread implementation of this practice is lacking.

Copy number variation in the CES1 gene and the risk of non-alcoholic fatty liver in a Chinese Han population

A recent genome-wide copy number variations (CNVs) scan identified a 16q12.2 deletion that included the carboxylesterase 1 (CES1) gene, which is important in the metabolism of fatty acids and cholesterol. We aimed to investigate whether CES1 CNVs was associated with susceptibility to non-alcoholic fatty liver disease (NAFLD) in a Chinese Han population. A case–control study was conducted among 303 patients diagnosed with NAFLD and 303 age (± 5) and sex-matched controls from the Affiliated Nanping First Hospital of Fujian Medical University in China. The copy numbers of CES1 were measured using TaqMan quantitative real-time polymerase chain reaction (qPCR) and serum CES1 was measured using enzyme-linked immunosorbent assays. The Chi-squared test and a logistic regression model were used to evaluate the association between CES1 CNVs and NAFLD susceptibility. The distribution of CES1 CNVs showed a higher frequency of CNVs loss (< 2) among patients; however, the difference was not significant (P = 0.05). After controlling for other known or suspected risk factors for NAFLD, CES1 CNVs loss was significantly associated with greater risk of NAFLD (adjusted OR = 2.75, 95% CI 1.30–5.85, P = 0.01); while CES1 CNVs gain (> 2) was not. There was a suggestion of an association between increased CES1 serum protein levels and CNVs losses among cases, although this was not statistically significant (P = 0.07). Copy number losses (< 2) of CES1 contribute to susceptibility to NAFLD in the Chinese Han population.

Optimization of postoperative opioid prescriptions in gynecologic oncology: Striking a balance between opioid reduction and pain control

ObjectiveTo implement a quality-improvement initiative to assess the impact various patient and procedural factors have on postoperative opioid use. To develop a tailored opioid prescribing algorithm for gynecologic oncology patients. MethodsA retrospective cohort study was performed of patients who underwent a laparoscopy or laparotomy procedure for a suspected or known gynecologic malignancy between 3/2019–9/2020. Patients were assessed preoperatively for the presence of suspected risk factors for opioid misuse (depression, anxiety, chronic pain, current opioid use, or substance abuse). Patients completed a 30-day postoperative questionnaire assessing for total opioid pill use and refills requests. Multivariate models were developed to estimate the independent effect of sociodemographic characteristics, risk factors for opioid misuse and procedural factors on patient reported postoperative opioid use. ResultsA total of 390 patients were analyzed. Thirty-nine percent (N = 151/390) of patients reported not using opioids after discharge and 5% (N = 20/390) received an opioid refill.For both minimally invasive procedures and laparotomy procedures, body mass index, comorbidities, intraoperative or postoperative complications and final diagnosis of malignancy were not associated with the amount of opioid consumption. However, younger age and history of risk factors for opioid misuse significantly impacted postoperative opioid use. In multivariate analysis, age (p = 0.038) and risk factors (p < 0.001) remained significant after controlling for other factors. ConclusionsTwo out of every five patients did not use opioids after surgery. Younger patients and those with risk factors for opioid misuse need a tailored approach to prescribing opioids to balance the need for adequate pain control with the risk of misuse.

Abstract 845: Association of nut consumption with risk of total and specific cancers: Evidence from three large prospective cohort studies

Abstract Background The associations between nut consumption, especially specific types of nuts, and cancer risk have not been extensively investigated. Methods Nut consumption and other risk factors were assessed at baseline and updated every 2 to 4 years in the Nurses' Health Study (1980 to 2014), the Nurses' Health Study II (1991 to 2015), and the Health Professionals Follow-up Study (1986 to 2018). We examined the associations between the intake of total and specific types of nuts and the risk of total cancer, as well as common cancers with a high incidence including cancers of lung, colorectum, breast, bladder, and aggressive prostate cancer among participants who were free of cancer, heart disease, and stroke at baseline. Cox proportional hazards models were used to obtain the hazard ratios (HRs) and 95% confidence intervals (95% CIs) in each cohort separately as well as pooled. To check the robustness of simply pooled HRs, we pooled the HRs in each cohort with meta-analysis using both random-effect model and fixed-effect model. We also added a 12-year lag period between nut-intake assessment and each follow-up period. Results During a median of 26.8 years of follow-up (1,015,834 person-years) in HPFS, 35.4 years (2,575,205 person-years) in NHS, 26.0 years (2,282,632 person-years) in NHSII, we documented 44,561 incidence cancer cases, including 3,972 lung cancer, 4,184 colorectal cancer, 1,588 bladder cancer, 10,936 breast cancer, and 1,171 aggressive prostate cancer cases. As compared to non-consumers, the pooled multivariable HRs of total nut consumption for five or more servings/week were 0.99 (95% CI: 0.94 to 1.04, P trend = 0.52) for total cancer, 0.88 (95% CI: 0.74 to 1.03, P trend = 0.16) for lung cancer, 1.08 (95% CI: 0.92 to 1.26, P trend = 0.87) for colorectal cancer, 0.90 (95% CI: 0.71 to 1.14, P trend = 0.64) for bladder cancer, 0.96 (95% CI: 0.85 to 1.08, P trend = 0.34) for breast cancer and 1.18 (95% CI: 0.92 to 1.51, P trend = 0.52) for aggressive prostate cancer. The associations between specific types of nuts and risk of total and specific cancers were also null. In the latency analysis, we did not observe any significant associations between nut consumption and 12-year latent risk of cancer in the pooled data. Conclusions In three large prospective cohorts of health professionals, frequent nut consumption was not associated with risk of total cancer and major individual cancers after adjustment for known or suspected risk factors. Citation Format: Zhe Fang, You Wu, Yanping Li, Xuehong Zhang, Walter Willett, A. Heather Eliassen, Bernard Rosner, Mingyang Song, Lorelei Mucci, Edward Giovannucci. Association of nut consumption with risk of total and specific cancers: Evidence from three large prospective cohort studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 845.

A case control study on the risk factors of non-syndromic orofacial clefts

Background: Orofacial clefts (OFCs) are the most common craniofacial malformation of the new born in the world. In India OFCs are the 3rd most common congenital anomaly following anencephaly and club foot. Objectives were to study the association of family history, medications during pregnancy, passive smoking with non-syndromic OFC, and to determine the pattern of OFCs in the study population.Methods: This is a hospital-based, matched case-control study conducted in a tertiary care centre, Thrissur, Kerala. We interviewed 30 mothers of children affected by non-syndromic OFCs. Mothers were asked about their sociodemographic details and other suspected risk factors using a semi structured questionnaire.Results: In our study unilateral left sided cleft lip was found to be more prevalent 62%. Those who had a family history of OFCs was found to have a significantly higher risk of OFC (OR 26.333). Medications for diabetes mellitus, hypertension, thyroid dysfunction, bronchial asthma, analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) during first trimester of pregnancy posed a higher risk for OFCs (OR 7.222). Maternal age at pregnancy greater than or equal to 30 was also found to be a significant risk factor.Conclusions: In our study we found out that family history is a risk factor for OFCs. We conclude that exposure of the mother to passive smoking should be avoided during pregnancy and family members should be made aware of the health hazards of passive smoking. Medications should only be taken after consulting a doctor preferably an obstetrician. Self-medication during pregnancy should be strictly avoided.

Thyroid Disorders in Pregnancy: Role of Routine Antenatal Thyroid Screening

Background &amp; objective:Thyroid disorders are among the common endocrine problems during pregnancy with well-known adverse effects on both mother and fetus. Many of these adverse effects could be prevented or ameliorated by early detection and appropriate treatment of conditions, provided routine antenatal thyroid screening is done. Considering this view, the present study was aimed to find the prevalence of thyroid disorders and their spectrum in pregnancy in order to justify the necessity of routine antenatal thyroid screening.&#x0D; Methods: This cross-sectional study was conducted in the Department of Obstetrics &amp; Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period 1 year from July 2012 to June 2013 on pregnant women to screen for the thyroid disorders in pregnancy. Based on predefined eligibility criteria, a total of 246 pregnant women up to 36 weeks of gestation were consecutively included in the study. A short history with brief physical examination was done followed by collection of blood samples. Thyroid function was assessed by measuring serum levels of thyroid stimulating hormone (TSH). Serum free thyroxin (FT4) level was estimated in 71 cases, where TSH value was deranged. Trimester specific reference range of serum TSH was used to define hypothyroid, euthyroid and hyperthyroid cases. The suspected risk factors were then compared between abnormal and euthyroid groups to find their association with thyroid disorders.&#x0D; Result: The results of the study showed that the overall prevalence of abnormal thyroid function status was 30.9% (hypothyroidism 29.7% and hyperthyroidism 1.2%) based on normal range of serum TSH in different trimesters of pregnancy. Pregnant women with thyroid disorders were generally older than their euthyroid counterparts (p = 0.039). Hypothyroid state was fairly common with advancing gestation (21.3%, 30.3% and 34% in the 1st, 2nd, and 3rd, trimesters respectively). Pregnant women with personal or family history of thyroid disease in the past exhibited a higher prevalence of abnormal thyroid function than those who did not have such history (p = 0.041 and p = 0.044 respectively). Past menstrual irregularity, past history of subfertility or abortion were significantly associated with thyroid disorders (p = 0.042, p = 0.004 and p &lt; 0.001 respectively). Presence of goitre (21.1%) in current pregnancy also showed significant association with thyroid dysfunction (p = 0.001). The risk of developing abnormal thyroid function was observed to be 3.6(95% CI = 1.9 – 6.4) times higher in those who had at least one risk factor than those who did not have any risk factors (p &lt; 0.001). However, a sizable portion (27.6%) of pregnant women without any risk factors developed abnormal thyroid function.&#x0D; Conclusion: The study concluded that one in every three women may have thyroid disorder during pregnancy, primarily hypothyroidism. Adopting risk factor-based screening for thyroid disorders in pregnancy, there is every chance that a substantial number of cases with thyroid dysfunction may be missed. Therefore, routine antenatal thyroid screening is recommended.&#x0D; Ibrahim Card Med J 2020; 10 (1&amp;2): 74-83

Venous Thromboembolism in Trauma: The Role of Anticoagulation and Inferior Vena Cava Filters.

Venous thromboembolism (VTE) is a significant contributor to morbidity and mortality among patients with severe trauma. Historically, prophylactic inferior vena cava filters (IVCFs) were used in high-risk trauma patients with suspected risk factors for VTE, including prolonged immobilization, and concurrent contraindication to anticoagulation. Mounting data regarding the efficacy of IVCF in this cohort, as well as concerns regarding morbidity of an in situ IVCF, have challenged this practice paradigm. In this review, we discuss the comanagement of VTE and trauma, including anticoagulation and the use of IVCF.

Virtual powers of observation: A telemedicine approach for the suspected COVID-19 patient.

Prior to COVID-19, telemedicine and its applications to the emergency department (ED) had made significant inroads toward remote evaluation and care. During the local peak of the COVID-19 pandemic in New York City (NYC), there was a dramatic increase in telemedicine based patient encounters for suspected COVID-19 symptoms. In response, pathways were developed to promote a standardized telemedicine approach to remote evaluation and assessment of suspected COVID-19 patients. A pathway was developed and implemented at two academic EDs in NYC, which collectively had approximately 8,300 telemedicine visits for suspected COVID-19 from March 2020 to June 2020. A protocol was developed by an expert consensus panel of four board-certified emergency physicians and two pediatric emergency physicians, all with telemedicine training/administrative roles. The pathway was initiated for any telehealth patient with suspected COVID-19 symptoms (cough, fever, shortness of breath, and bodyaches). A standardized history solicited known or suspected risk factors for worse prognosis, including age > 50, cardiovascular or lung disease, obesity, immunosuppression, and living alone, as well as a focused assessment of symptom severity and exercise tolerance. An exam at rest included visual counting of breaths along with instruction on palpation of radial pulse. Saturation was included if pulse oximetry was available. If exam at rest was reassuring, providers were instructed to repeat the respiratory assessment on exertion by having the patient walk in place briskly for 1 minute. Patients with severe illness defined by resting or exertional respiratory rate greater than 30 and/or oxygen saturation less than 90 percent were instructed to go to the ED. Patients with moderate illness defined by exertional metrics of respiratory rate less than 22, oxygen saturation greater than 94 percent, and heart rate less than 125 were discharged from the virtual urgent care visit with a repeat telehealth follow-up call at either 12 or 24 hours depending on the number of risk factors. Patients without risk factors and with reassuring respiratory assessment were discharged from the telemedicine encounter with reassurance and standard discharge precautions for escalation of care. Designing and disseminating a standardized pathway helped to provide a framework to approach patients suspected of COVID-19 over telemedicine. Future work focusing on patient outcome data will help guide and refine any standardized telehealth approach to the COVID-19-suspected patient.

Periinterventional Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage Predicts an Unfavorable Clinical Course

ABSTRACT BACKGROUND Preliminary evidence exists that ultra-early angiographic vasospasm (UEAV) after aneurysmal subarachnoid hemorrhage (SAH) is associated with delayed cerebral vasospasm (DCVS), delayed cerebral ischemia (DCI), and poor functional outcome. Typically, detection of UEAV has been based on admission radiological imaging. OBJECTIVE To elucidate the occurrence of the phenomenon of UEAV during treatment in SAH patients. METHODS A total of 206 consecutive patients underwent either endovascular or microsurgical treatment in a hybrid operating room within 48 h after SAH. Time to DCVS and DCI, and poor functional outcome (both binary) were analyzed using Cox proportional-hazards and logistic regression models. We examined both univariable models (admission and periinterventional UEAV) and multivariable models (backward variable selection, including further known and suspected risk factors). RESULTS For UEAV detected in 33 patients (16%), 10 were admission and periinterventional and 23 periinterventional only. Both admission and periinterventional UEAV significantly increased the risk of DCVS (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.2–2.3, P = .001), DCI (odds ratio [OR] 5.9, CI 1.7-25.1, P = .001), and poor functional outcome (OR 4.7, CI 1.7-13.4, P = .004). Clipping, female sex, and higher Barrow Neurological Institute (BNI) scale increased the hazard for DCVS and the probability for DCI, whereas increasing patient age, poor initial World Federation of Neurological Surgeons (WFNS) grade, and intraparenchymal hemorrhage increased the probability for poor functional outcome. CONCLUSION Detection of admission or periinterventional UEAV poses high risk of DCVS, DCI, and poor outcome after SAH. Therefore, periinterventional UEAV should be considered an important warning sign that warrants both early monitoring and aggressive therapy.

Rapid Universal Early Screening for Alzheimer's Disease and Related Dementia&amp;nbsp;via Pattern Discovery in Diagnostic History

Alzheimer’s disease (AD) is a progressive, incurable and ultimately fatal neurodegenerative condition. In this study, we introduce the Zero-burden Co-morbid Risk (ZCoR) score to screen for the future risk of AD and related dementia (ADRD) 1 − 10 years before a clinical diagnosis. Requiring no new bloodwork or cognitive tests, ZCoR leverages uncharted comorbidity patterns, to potentially enable near-instantenous universal point-of-care screening of entire patient populations. In validation, ZCoR (n = 729, 018) achieves out-of-sample AUC > 90% for predicting a diagnosis immediately after screening, an AUC > 87% for a diagnosis made one year earlier than in current practice, and maintaining over > 80% AUC for predictions made a decade earlier, irrespective of sex. We achieve high predictability in patient slacking any of the currently suspected risk factors; demonstrating effectiveness in cohorts at higher risk of missed diagnoses. Additionally, ZCoR can target mild cognitive impairment (MCI) with performance at par with questionnaire-based assessments (AUC 88 − 90%), maintaining high effectiveness (AUC ≈ 80%) for predicting impairment up to 3 years into the future. Powered by stochastic learning algorithms that enhance standard machine learning, ZCoR enables discovery in electronic heath record databases, can reduce ADRD and MCI diagnostic delays, and the impact of socio-economic and demographic variables, with immediate impact on patient outcomes.

Predictors of transfusion in adults undergoing elective posterior thoracolumbar spinal fusion: a retrospective case series

Background: Posterior thoracolumbar spinal fusion surgery can be associated with significant blood loss. The purpose of this study was to investigate suspected risk factors of blood transfusion in posterior thoracolumbar fusion patients and determine if blood transfusion had a negative impact on the outcomes for those patients after surgery. Methods: All adults undergoing posterior thoracolumbar spine fusion in our institution from May 2015 to May 2018 were included. Data collected included demographic data as well as body mass index (BMI), preoperative hemoglobin, American Society of Anesthesiologists (ASA) classification, change in hemoglobin, estimated blood loss, incidence of blood transfusion, number of units transfused, number of levels fused, length of stay, and readmission within 30 days. The data were analyzed to correlate these variables with the frequency of blood transfusion and to assess the association of adverse outcomes after blood transfusion. Results: This study included 125 patients. Six patients (4.8%) required readmission within the first 30 days after discharge. Length of stay averaged 8.4 days (range 3 to 74). Eighteen patients (14.4%) required blood transfusion perioperatively. When multiple variables were analyzed for any correlations, the number of levels fused, age, and BMI had statistically significant correlations with the need for blood transfusion (P&lt;0.005). None of the other factors showed any statistically significant correlation. Patients who required blood transfusion were more likely to stay in the hospital more than 7 days (P&lt;0.005). Conclusions: Patients undergoing posterior thoracolumbar fusion are more likely to require blood transfusion if they are older, have a higher BMI, or have a multilevel fusion. Receiving a blood transfusion is associated with increased complication rates. Level of Evidence: Level IV.

Abstract IA23: Cadmium exposure, DNA methylation and liver cancer

Abstract Background. In the last 30 years, the incidence of hepatocellular carcinoma (HCC) has increased faster than other solid tumors and race/ethnic disparities are widening, yet suspected risk factors whose prevalence has also been on a parallel increase, cannot fully explain either this steep increase in incidence or the widening racial/ethnic gap. An understudied, yet potent risk-factor whose prevalence has been on the increase and disproportionately affects ethnic minorities, is exposure to environmental contaminants e.g., cadmium—a probable carcinogen whose main target organ is the liver. Methods. We measured cadmium concentrations in maternal blood samples obtained prenatally using inductively coupled plasma mass spectrometry. In umbilical cord blood leukocytes, we measured DNA methylation at a regulatory sequence controlling the expression of the gene cluster that includes DLK1, MEG3, MEG9, MEG8, DIO3 and some SNORD genes. Hyper-methylation at this sequence region—the first exon of MEG3—has been associated with HCC. We used zip-code level North Carolina Cancer Registry data to estimate liver cancer incidence, and Getis-Ord Gi* statistic and regression models to evaluate the relationships among cadmium exposure, MEG3 hyper-methylation and HCC incidence. Results. We found that higher cadmium concentrations were associated with significant MEG3 hypermethylation (p=0.03), and associations were specific to African Americans (p=0.01). We also found a significant geographic cluster of MEG3 hypermethylation, in the zip-code with the highest liver cancer incidence (p=0.01). ~75% of which HCC. Conclusion. Our data suggest that hypermethylation of the sequence that regulates MEG3, an established tumor suppressor is associated with cadmium exposure early life and HCC in adults. A comprehensive characterization of other networks that are altered in response to environmental exposures that disproportionately affect ethnic minorities, is urgently needed. Citation Format: Catherine Hoyo. Cadmium exposure, DNA methylation and liver cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA23.

Hydroxychloroquine in the prevention of COVID-19 mortality.

Hydroxychloroquine in the prevention of COVID-19 mortality.

Teriparatide Did Not Increase Adult Osteosarcoma Incidence in a 15-Year US Postmarketing Surveillance Study.

ABSTRACTThe Osteosarcoma Surveillance Study was initiated in the United States in 2003 to monitor for a potential association between the osteoporosis treatment teriparatide and osteosarcoma. Osteosarcoma occurs at a background incidence rate of approximately 2.5 cases per million per year in US adults aged 40 years or older. For this study, incident cases of osteosarcoma diagnosed between January 1, 2003, and December 31, 2016, were identified through participating cancer registries in the United States. Information on prior exposure to medications and possible risk factors was obtained by self‐report (or proxy report) in telephone interviews. Exposure information was verified through medical record abstraction for a sample of patients. A standardized incidence ratio was estimated to compare the observed and expected numbers of osteosarcoma patients with a prior history of teriparatide treatment. Interviews were completed for 24% (1173) of patients diagnosed with osteosarcoma between 2003 and 2016; three reports of teriparatide use before diagnosis were identified. Based on the background incidence rate, the expected number of osteosarcoma cases among patients treated with teriparatide was 4.17. Given the three observed cases, the standardized incidence ratio was 0.72 (90% confidence interval [CI], 0.20 to 1.86). Demographic characteristics were similar for interviewed and noninterviewed patients. Agreement was >90% between self‐reported and chart‐recorded exposure to osteoporosis medications. Mean age of interviewed patients was 61 years; 53% of patients were male, 84% were white, and 5% were Hispanic. The prevalence of suspected risk factors for development of osteosarcoma among the osteosarcoma cohort was 19% for history of radiation and 4% for history of Paget's disease of bone. These findings showed that the incidence of osteosarcoma associated with teriparatide use during the 15‐year surveillance period was no different than would be expected based on the background incidence rate of osteosarcoma. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Lifetime exposure to disinfection by-products and risk of cancer at six anatomic sites in Iowa, USA

Background: Disinfection by-products (DBPs) are suspected risk factors for multiple cancers. In our population-based case-control study in Iowa, we previously found moderate risks of bladder, brain, and rectal (but not colon, kidney, or pancreatic) cancers with duration of use of chlorinated surface water, known to have elevated DBP levels. We reanalyzed these data using quantitative estimates of lifetime DBP exposure. Methods: We identified 1,225 bladder, 586 colon, 566 rectal, 311 brain, 334 kidney, and 302 pancreatic cancer cases and 2,106 controls (1986-1989). We developed historical annual estimates of total trihalomethanes (TTHM) and the sum of five haloacetic acids (HAA5) levels for Iowa public water supplies. Using residential water source histories for each participant, we computed lifetime average exposure (µg/L) and exposure years above the U.S. maximum contaminant levels (MCL) for TTHM (&gt;80 µg/L) and HAA5 (&gt;60 µg/L); private well users were assumed to have no DBP exposure. We estimated odds ratios (ORs) and 95% confidence intervals (CI) for exposure quantiles from logistic regression models adjusted for potential confounders.Results: Rectal cancer risk was associated with lifetime average TTHM exposure above the 93.5th percentile (≥51.7 µg/L; OR=1.56, 95%CI=1.0-2.6; p-trend=0.02) and with 25+ years of exposure to levels above the MCL (OR=1.65, 95%CI=1.0-2.7; p-trend=0.05) but not with shorter duration; results were similar for men and women. Lifetime average TTHM exposure was not significantly associated with other cancers. 25+ years of exposure ≥80 µg/L TTHM was associated with increased odds of colon (OR=1.96, 95%CI=1.1-3.5), bladder (OR=1.38, 95% CI=1.0-2.0), and brain (OR=2.59, 95%CI=1.0-6.4) cancer among men, but not women or for shorter duration of exposure at this level. We observed sporadic positive associations with HAA5 exposures across cancer sites.Conclusions: Our findings contribute new quantitative evidence of associations between high levels of TTHM and rectal, colon, bladder, and brain cancers.