WC Patients Research Articles

Does breast Cancer have a lower risk of mortality from Severe Acute Respiratory Syndrome compared to other types of Cancer? Evidence from Brazil, a heterogeneous population

To investigate the prevalence of hospitalizations and deaths related to severe acute respiratory syndrome in Brazilian women diagnosed with breast cancer. A 12-month retrospective study was performed using data from hospitalized women patients resulting from SARS-CoV-2 infection from a national database of acute respiratory lower disease notification forms (ARDL) between January 1 and December 2021. Data from non-pregnant and non-puerperium women> 18 years and with laboratory, COVID-19 diagnosis were selected and analyzed from 1048575 databank patients and categorized into three groups: without cancer diagnosis (WC), with breast cancer (BC), and with a diagnosis of other types of cancer (OC). OC was also sub-categorized in eight types of diagnosed cancer. Mortality and other clinical complications during the hospitalized period were compared between groups by analysis of variance followed by the post hoc Bonferroni test and the chi-square test. The influence of the following covariates was determined by multivariate logistic regression analysis: age, education, ethnicity, previous immunization to COVID-19, and presence of risk comorbidities. Brazilian BC had a lower risk of mortality from ARDL-COVID than those diagnosed OC patients. However, both groups presented a higher mortality risk than WC patients. Conclusions: These results are like some previous studies suggesting that BC lower risk could be a universal phenomenon independent of ethnicity and the presence of other risk comorbidities for COVID-19.

Narcotic Use and Prescribing Trends Among Workers Compensation Patients Undergoing Foot and Ankle Surgery

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Previous studies have shown that workers compensation patients (WC) have worse outcomes, and higher complications rates after orthopaedic surgery. Despite orthopaedic surgeons being the third highest prescribers of narcotic pain medication in the United States there have been no studies to specifically evaluate narcotic use among the WC population. The purpose of this study was to investigate narcotic use among WC patients who underwent foot or ankle operative procedures compared with a procedure matched control group. Methods: A retrospective review was conducted for WC and non-WC patients ages 18 to 70 years old who underwent foot (CPT 28001-28899) or ankle (CPT 27600-27899) procedures in an orthopaedic surgery practice from October 2017 through January 2020. Data collection included demographics, social, surgical, perioperative follow-up and complications. Outcomes measures were timing and number of narcotic prescriptions, total morphine milligram equivalents (MME), and procedure type. Data analysis was performed with SPSS version 28. Comparisons were conducted with Mann-Whitney U test, chi square test, or Fisher’s exact test. Power analysis determined sample size with a 0.05 alpha level, 0.80 power, and 0.5 effect size. Results: 142 total patients met inclusion criteria, with 71 WC patients and 71 non-WC patients. There were no differences regarding the type of foot or ankle procedure performed (p=0.598). WC patients had double the number of overall narcotic prescriptions (median 2 vs 1; p < 0.001). WC patients were prescribed in total 1,125 oxycodone MME and 871.8 hydrocodone MME (P < 0.001), versus 750 oxycodone MME and 450 hydrocodone MME among the non-WC group (p < .008). There was no difference in the number of tramadol prescriptions (p = 0.571). WC patients experienced more days between the date of last narcotic prescription and both index surgery date (median 27 vs 1, p = 0.001) and initial clinic visit date (median 105 vs 49, p = 0.002). Conclusion: This data demonstrates that WC patients portend worse outcomes and utilize narcotics at twice the rate and for longer periods of time post-operatively than non-WC patients. Increased narcotic use may potentiate narcotic dependence and likely leads to worse outcomes. Treating physicians must be aware of these trends in order to best manage these patients. Physicians may need to have longer discussions with WC patients regarding narcotic use post operatively as well as about outcomes and goals of surgery. Physicians should set early expectations with WC patients and clear limits on the amount of narcotics they are willing to prescribe postoperatively.

Influence of Prolonged Duration of Symptoms Before MIS-TLIF in a Workers' Compensation Population

We assessed the potential effect of the preoperative symptom duration on patient-reported outcomes (PROs) for workers' compensation (WC) patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). WC patients who had undergone primary, elective MIS-TLIF with recorded symptoms duration data available were included. Two cohorts were generated: those with a shorter (lesser) duration (LD; symptom duration <1 year) and those with a prolonged duration (PD; symptom duration >1 year). PROs were collected preoperatively and at several follow-up points for ≤1 year postoperatively. The PROs were compared within and between the 2 cohorts. The achievement rates of minimum clinically important differences were also compared between the 2 cohorts. A total of 145 patients were included, with 76 in the PD cohort and 69 in the LD cohort. The LD cohort demonstrated improvement in the patient-reported outcomes measurement information system for physical function (PROMIS-PF) at 6 months and 1 year postoperatively, Oswestry disability index (ODI) at 12 weeks and 6 months postoperatively, visual analog scale (VAS) score for back pain at 6 weeks, 12 weeks, and 6 months postoperatively, and VAS score for leg pain at all postoperative points (P ≤ 0.015 for all). The PD cohort demonstrated improvement in the PROMIS-PF at 12 weeks and 6months postoperatively, ODI at 6 weeks, 12 weeks, and 6 months postoperatively, and VAS score for back pain and leg pain at all postoperative periods (P ≤ 0.007 for all). All the preoperative PROs were superior for the LD cohort (P < 0.001 for all). The LD cohort reported better PROMIS-PF at 6 months and 1 year and ODI at 1 year postoperatively (P≤ 0.037 for all). The PD cohort was more likely to achieve a minimum clinically important difference in ODI at 6 and 12 weeks postoperatively, VAS score for back pain at 6 weeks postoperatively, and VAS score for leg pain at 6 weeks and 1 year postoperatively and overall (P ≤ 0.036 for all). Independently of the preoperative symptom duration, WC patients demonstrated improvement in physical function and pain after MIS-TLIF. Patients with a longer symptom duration reported inferior function and pain preoperatively and were more likely to demonstrate clinically significant improvements in disability and pain postoperatively.

ASTHMATIC PATIENTS ARE AT RISK FOR EXACERBATIONS IRRESPECTIVE OF CONTROL, MAINTENANCE ADHERENCE, OR DISEASE SEVERITY

<h3>Introduction</h3> The MANDALA study showed decreased exacerbation risk with and as-needed short-acting beta₂-agonist (SABA)-inhaled corticosteroid (ICS) fixed-dose combination vs as-needed SABA in uncontrolled moderate-to-severe asthma. To understand the broader applicability of these findings, we assessed relationships between severe exacerbations and asthma control, maintenance adherence, and disease severity in patients using as-needed SABA. <h3>Methods</h3> IBM MarketScan databases (2010-2017) for US patients aged ≥12 years receiving SABA for asthma were evaluated. Patients were indexed on a random SABA fill, had 12 months' continuous eligibility pre/post-index, and ≥1 post-index maintenance claim. Control was defined by SABA fills (well-controlled [WC, index SABA only], not well-controlled [NWC, 2–3 SABA], very poorly controlled [VPC, ≥4 SABA]); adherence by maintenance medication possession ratio (MPR: ≥80%, 50-79%, <50%); and disease severity defined by maintenance group. Relationships between control, adherence, severity, and severe exacerbations were analyzed descriptively (Chi-square; significance p≤0.05). <h3>Results</h3> Among 351,870 patients: 31% WC, 35% NWC, 34% VPC; 13% adherence ≥80%, 23% 50–79%, 64% <50%. A lower proportion of VPC patients with ≥80% adherence experienced exacerbations than those with <80% adherence (p<0.0001), but adherence was unrelated to exacerbations for WC (p=0.11) or NWC (p=0.46) patients. Better control coupled with greater adherence was associated with reduced exacerbation occurrence. Across maintenance levels, however, 36–54% of WC patients with ≥80% adherence experienced exacerbations (<b>Figure</b>). <h3>Conclusion</h3> Many asthmatics are at risk for exacerbations irrespective of control, adherence, or disease severity. As-needed SABA-ICS should be considered broadly to mitigate variability in airway inflammation that could lead to asthma exacerbations.

Abnormal effective connectivity in the sensory network in writer’s cramp

BackgroundWriter’s cramp (WC), a task specific form of dystonia, is considered to be a motor network disorder, but abnormal sensory tactile processing has also been acknowledged. The sensory spatial discrimination threshold (SDT) can be determined with a spatial acuity test (JVP domes). In addition to increased SDT, patients with WC exhibited dysfunctional sensory processing in the sensory cortex, insula, basal ganglia and cerebellum in a functional magnetic resonance imaging (fMRI) study while performing the spatial acuity test. ObjectivesTo assess whether effective connectivity (EC) in the sensory network including cortical, basal ganglia, thalamic and cerebellar regions of interest in WC patients is abnormal. MethodsWe used fMRI and applied a block design, while 19 WC patients and 13 age-matched healthy controls performed a spatial discrimination task. Before we assessed EC using dynamic causal modelling, we compared three model structures based on the current literature. We enclosed regions of interest that are established for sensory processing during right hand stimulation: Left thalamus, somatosensory, parietal and insular cortex, posterior putamen, and right cerebellum. ResultsThe EC analysis revealed task-dependent decreased unidirectional connectivity between the insula and the posterior putamen. The connectivity involving the primary sensory cortex, parietal cortex and cerebellum were not abnormal in WC. The two groups showed no differences in their behavioural data. ConclusionsPerception and integration of sensory information requires the exchange of information between the insula cortex and the putamen, a sensory process that was disturbed in WC patients.

Degradation of connexin 50 protein causes waterclefts in human lens.

Cataracts are mainly classified into three types: cortical cataracts, nuclear cataracts, and posterior subcapsular cataracts. In addition, retrodots and waterclefts are cataract subtypes that cause decreased visual function. To maintain an orderly and tightly packed arrangement to minimize light scattering, adhesion molecules such as connexins and aquaporin 0 (AQP0) are highly expressed in the lens. We hypothesized that some main and/or subcataract type(s) are correlated with adhesion molecule degradation. Lens samples were collected from cataract patients during cataract surgery, and mRNA and protein expression levels were measured by real-time RT-PCR and western blotting, respectively. The mRNA levels of adhesion molecules were not significantly different among any cataract types. Moreover, AQP0 and connexin 46 protein expressions were unchanged among patients. However, connexin 50 protein level was significantly decreased in the lens of patients with WC cataract subtype. P62 and LC3B proteins were detected in the WC patients’ lenses, but not in other patients’ lenses. These results suggest that more research is needed on the subtypes of cataracts besides the three major types of cataract for tailor-made cataract therapy.

Task-specific interhemispheric hypoconnectivity in writer’s cramp – An EEG study

ObjectiveWriter’s cramp (WC) is a focal task-specific dystonia characterized by abnormal posturing of the hand muscles during handwriting, but not during other tasks that involve the same set of muscles and objects such as sharpening a pencil. Our objective was to investigate the pathophysiology underlying the task specificity of this disorder using EEG. We hypothesized that premotor-parietal connectivity will be lower in WC patients specifically during handwriting and motor imagery of handwriting. MethodsWe recruited 15 WC patients and 15 healthy controls. EEG was recorded while participants performed 4 tasks – writing with a pencil, sharpening a pencil, imagining writing and imagining sharpening. We determined the connectivity changes between relevant brain regions during these tasks. ResultsWe found reduced interhemispheric alpha coherence in the sensorimotor areas in WC patients exclusively during handwriting. WC patients also showed less reduction of task-related beta spectral power and a trend for reduced premotor-parietal coherence during motor tasks. ConclusionWe could not confirm an abnormality in premotor-parietal connectivity specific to handwriting by this method. However, there was a task-specific reduction in interhemispheric alpha connectivity in WC patients, whose behavioral correlate remains unknown. SignificanceInterhemispheric alpha connectivity can be a potential interventional target in WC.

Central hemodynamic characteristics of young adults with isolated systolic hypertension: an ambulatory blood pressure monitoring-based study of real-world clinical patients.

The central hemodynamic characteristics of young adults with isolated systolic hypertension (ISH) remain controversial, particularly regarding the extent of pulse pressure amplification (PPamp) compared with that of normotensives (NTs). Given the lack of ambulatory blood pressure monitoring (ABPM)-based data, this study evaluated 509 untreated young adults (18-35 years) who had undergone ABPM during the last decade, 109 who had undergone both ABPM and SphygmoCor analysis, and 26 newly recruited NTs. The agreement rate between office BP- and ABPM-based subtype classification was alarmingly low (50.7%). ISH was distinguishable from systolic-diastolic hypertension, the predominant subtype characterized by increased central BPs and stiffened arteries. The central hemodynamic parameters were all similar between patients with ISH and white-coat hypertension (WC). ISH patients had central BPs that were, albeit higher than those of NTs, at an upper-normal level that was comparable to those of WC patients. ISH patients had similar cfPWV but significantly higher PPamp than NTs (p = 0.032). The central hemodynamic parameters of the participants were further analyzed according to central pressure waveform types (A vs. B vs. C). Type C waves were associated with the highest PPamp and lowest cfPWV, whereas type A waves were associated with the lowest PPamp and highest cfPWV. Subjects with type B waves, an intermediate form, also had considerably high PPamps. Waveform composition differed significantly across hypertension subtypes (p < 0.001). ISH patients mostly had type B or C waves (96.7%), with only 3.3% having type A waves. This study based on a refined diagnosis showed that the ambulatory ISH of young adults arises from highly elastic arteries and related robustness of PPamp and shares similar central hemodynamic characteristics with WC patients.

Botulinum toxin and occupational therapy for Writer's cramp

BackgroundWriter's cramp (WC) is a form of focal hand dystonia, for which focal botulinum neurotoxin (BoNT) injections are the current best therapy. Past studies have shown that some types of rehabilitative therapy can be useful. We hypothesized that BoNT together with a specific type of occupational therapy would be better than BoNT alone for treating WC patients comparing the effects with a patient-rated subjective scale. MethodsTwelve WC patients were randomized to two groups. Six received only BoNT therapy and 6 received BoNT & occupational therapy. The occupational therapy involved specific exercises of finger movements in the direction opposite to the dystonic movements during writing. BoNT was injected by movement disorders neurologists in the affected muscles under electromyography-guidance. The primary outcome was the patient-rated subjective scale at 20 weeks. Secondary exploratory outcomes included the writer's cramp rating scale (WCRS), writer's cramp impairment scale (WCIS), the writer's cramp disability scale (WCDS), handgrip strength and kinetic parameters. ResultsThe patient-rated subjective scale scores at 20 weeks were not significantly different between the two groups. Significant objective improvement was noted in the BoNT & occupational therapy group, as noted by the decrease (28%) in WCIS scores. ConclusionsImprovement of the primary outcome measure, the patient-rated subjective scale, was not achieved. However, significant improvement was found in the BoNT & occupational therapy group in a secondary measure of impairment. Our hypothesis-driven study results are likely limited by small sample size, and further large-scale studies of occupational therapy methods to improve the efficacy of BoNT seems worthwhile.

Pathophysiology of writer\u2019s cramp: an exploratory study on task-specificity and non-motor symptoms using an extended fine-motor testing battery

BackgroundWriter’s cramp (WC) is a task-specific focal dystonia which manifests itself as abnormal postures interfering with motor performance. As the spread of motor symptoms remains controversial and non-motor symptoms are widely discussed, in this exploratory study, we explore the pathophysiology of WC, focusing on task-specificity and the psychological profiles of WC patients.MethodsIn 14 right-handed WC patients and matched controls, we assessed motor control by applying motor performance tests (Vienna Test Series), as well as using writing analysis and grip-force measurements. Moreover, detailed psychological factors were assessed. Classification trees were used to distinguish patients from controls.ResultsThe total duration of writing and the vertical writing frequency of the pen are the most important variables to split the data set successfully into patients and controls. No other variables concerning motor performance tests, grip-force measurements or psychological factors correctly separated patients and controls.ConclusionsOnly variables from the writing tasks successfully separated patients and controls, indicating a strong task-specificity of WC in our patient group. Future research should be performed with larger samples of untreated WC patients in early stages of impairment, without any secondary motor disturbances, to verify our findings.

MRI in primary focal dystonia

In 75 patients with focal dystonia (20 blepharospasm [BL], 15 spasmodic dysphonia [SD], 21 spasmodic torticollis [ST], 19 writer’s cramp [WC]) and 83 healthy controls, 3D T1-weighted, DT MRI and resting-state functional MR scans were obtained. Patients with BL showed decreased GM in the right postcentral gyrus, rolandic operculum, bilateral cerebellum and left supramarginal and parahippocampal gyri. SD patients showed decreased GM in bilateral superior frontal gyri, and bilateral rolandic operculum/insula and right temporal lobe compared to controls. In WC patients regions of GM increases were found in the right middle frontal gyrus and insula, left superior frontal and postcentral gyri, as well as in bilateral thalami. ST and controls had no difference in GM. Compared with controls, BL and SD patients showed a widespread pattern of WM damage, whereas changes were less pronounced in ST and WC. Patients with BL showed increased, while WC patients had decreased functional connectivity in sensorimotor network comparing to controls. ST patients showed no functional differences compared to controls. Patients with focal dystonia exhibit GM and WM alteration, and functional connectivity changes in regions highly relevant to motor function, sensory processing, and cognitive modulation of motor behavior.

Assessment of the Prevalence and Severity of Insomnia in a Chronic Disabling Occupational Spinal Disorder Population: An Underemphasized Symptom

19-82 years) and the mean age for WC patients was 46.5 years (range: 29-70 years). OUTCOME MEASURES: Patients completed a presurgical screening evaluation, including an interview with a psychologist, completing psychological questionnaires, as well as the MMPI-2-RF before spine surgery. METHODS: Patient who were referred for presurgical psychosocial screening completed questions and a structured interview. Data from these evaluations were compared for WC vs. Non-WC patients to determine if there were identifiable differences between these groups. RESULTS: Educational level differed significantly in the two groups with college completed by 35.7% of Non-WC vs. 8.3% of WC patients. Only 1.6% of Non-WC patients did not graduate from high school vs. 13.9% of WC patients. Pre-operatively, WC patients displayed relatively elevated sensitivity to symptoms reflected by higher scores on gastrointestinal problems, head pain, as well as neurological and cognitive complaint scales. WC patients’ MMPI-2-RF profiles displayed a greater sense of inefficacy, more behavior-restricting fears, more aggression, and a higher level of aberrant experiences. WC patients also reflected a greater sense of entitlement and demoralization. WC patients were not more fearful, worried, or depressed than Non-WC patients. CONCLUSIONS: Psychological factors have been reported to be related to surgical outcome. Compromised surgical outcomes in WC patients may be related to personality/behavioral factors that are more prominent in this population. This study found that WC patients had a lower level of education and had different personality profiles with respect to emotion, self-image, pain sensitivity and reported more physical complaints compared with Non-WC patients. Further investigation is underway to determine to what extent these factors contribute to the differences in surgical outcome. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.

POMD06 Utility of visual, tactile and mixed tasks in the determination of temporal discrimination thresholds in adult-onset primary torsion dystonia

Adult-onset primary torsion dystonia (AOPTD) is autosomal dominant with reduced penetrance. Sensory abnormalities in unaffected relatives may indicate nonmanifesting gene carriage—an ideal endophenotype being present in all patients and 50%...

97. Pre-Operative Expectations in Workman's Compensation Cases before Lumbar Spine Surgery

BACKGROUND CONTEXT: It has been shown that lower expectations regarding work status are associated with workman's compensation cases(WC). However, little research has been done regarding expectation of outcomes in WC patients.

Ethnic diversity in Type 2 diabetes

The present review assesses published data relating to the main ethnic groups in the UK Prospective Diabetes Study (UKPDS), namely White Caucasians (WC; 82% of the cohort), Indian-Asians (IA; 10%) and Afro-Caribbeans (AC; 8%). At entry, the IA patients were younger than WC and AC patients, had a greater waist-hip ratio and more sedentary lifestyle, but had the lowest prevalence of hypertension and current smoking. The AC patients had the poorest glycaemic control but the most favourable lipid profile. The differences in modifiable vascular risk factors did not change over 9 years of follow-up. Consistent with UKPDS exclusion criteria, few patients had complications at baseline and there were no between-group differences. An interim analysis of incident fatal/non-fatal myocardial infarction (median follow-up 8.7 years) showed that the AC patients had a 70% lower risk than WC after adjustment for explanatory variables and that IA patients had a similar risk to WC. An analysis of complete albuminuria and renal failure data (median follow-up 15 years) showed that IA ethnicity was independently associated with an increased risk. There are sustained ethnic differences in the nature of diabetes, including vascular risk factors. AC patients had a substantially reduced risk of myocardial infarction that was not explained by their more favourable lipid profile, while IA patients were more likely to develop nephropathy than WC and IA patients. Longer follow-up is needed to determine whether the increased macrovascular risk observed in IA patients in other studies is replicated in the UKPDS cohort.

High insulin requirements and poor metabolic control do not modify the expression, regulation and PKC mediated activation of the p21ras pathway in PBMC from type II diabetic patients.

Aims To asses whether clinically severe insulin resistance and poor metabolic control in patients with type II diabetes are associated with aberrant expression or function of the p21ras pathway. Methods We examined the expression and function of the p21ras pathway in resting and activated PBMC from 10 insulin treated patients with type II diabetes characterized by high insulin requirements and poor metabolic control (IR group) and 10 age and sex matched well controlled patients treated by diet alone or oral hypoglycemic medications (WC group). Results Levels of p21ras and its regulatory elements: p21rasGAP and hSOS1, were comparable in the two groups. The induced activities of p21ras and its associated down-stream regulatory enzyme MAP-kinase following TPA stimulation were also comparable in the IR and WC patients. Conclusions Taken together, these data indicate that clinically significant severe insulin resistance does not modify the expression, regulation and activation of p21ras pathway in PBMC of patients with type II diabetes.

Failed Anterior Acromioplasty

This report is a retrospective review of 51 patients, each of whom had a failed acromioplasty that was performed after presumptive diagnoses of impingement tendinitis. The purpose of the review is to analyze the failures, define their causes, and make recommendations regarding further management. Average age at time of initial surgery was 40 years (range, 20-64 years), and the follow-up period averaged 5.5 years (range, three to nine years). Thirty-four patients were found to have symptoms and signs that corresponded to a recognized clinical diagnosis and were thought to be sufficient to be a major cause of their pain. Twenty-three had a diagnosis other than continuing impingement. Success of a second surgical procedure was significantly greater in nonworker's compensation (WC) patients than in WC patients. Repeat acromioplasties in WC patients have poor results and are not recommended. Seventeen patients had no clear cause for their continuing shoulder tendinitis; however, time and supportive therapy allowed five patients to improve over an average 18-month period. In all categories, WC patients fared poorly, so prognosis must be guarded in this group. Non-WC patients may be helped with repeat surgery following an appropriate diagnosis for the cause of failure.