Year Decrease In Age Research Articles

Risk Factors for Failure of Tube Shunt Surgery: A Pooled Data Analysis

To identify the risk factors associated with failure of tube shunt surgery. Pooled analysis of 3 prospective multicenter, randomized clinical trials. A total of 621 patients with medically uncontrolled glaucoma were enrolled, including 276 from the Ahmed Baerveldt Comparison Study, 238 from the Ahmed Versus Baerveldt Study, and 107 from the tube group of the Tube Versus Trabeculectomy Study. Patients were randomized to treatment with an Ahmed glaucoma valve (model FP7) or Baerveldt glaucoma implant (model 101-350). The associations between baseline risk factors and tube shunt failure were assessed using a Cox proportional hazards regression model. The primary outcome measure was the rate of surgical failure defined as intraocular pressure (IOP) > 21 mmHg or reduced <20% from baseline, IOP ≤ 5 mmHg, loss of light perception vision, reoperation for glaucoma, or removal of implant. The cumulative probability of failure after tube shunt surgery was 38.3% after 5 years. In multivariable analyses, baseline factors that predicted tube shunt failure included preoperative IOP (≤ 21 mmHg compared to IOP > 21 and ≤ 25 mmHg; HR, 2.34; 95% CI, 1.52-3.61; P < .001), neovascular glaucoma (HR, 1.79; 95% CI, 1.28-2.52; P = .001), randomized treatment (for Ahmed glaucoma valve; HR, 1.36; 95% CI, 1.04-1.78; P = .025), and age (for 10 year decrease in age; HR, 1.19; 95% CI, 1.09-1.31; P < .001). Lower preoperative IOP, neovascular glaucoma, Ahmed implantation, and younger age were predictors of tube shunt failure. This Study provides the largest prospectively collected dataset on tube shunt surgery.

Retrospective Chart Review Examining Differences and Timelines in Recommended and Delivered Wheelchair Equipment in a Midwestern Dedicated Seating Department

ObjectiveTo compare recommended wheeled mobility equipment with delivered equipment, excluding custom seats and backs, considering demographic factors, such as sex, age, and funding source, as well as the timeline of the procurement process. DesignRetrospective chart review. SettingDedicated wheelchair seating department within a Midwestern rehabilitation hospital and associated complex rehabilitation technology durable medical equipment suppliers. ParticipantsWheelchair recommendations (N=546) made between January 1, 2017, and December 31, 2017, to physician-referred wheelchair users of all ages and diagnoses. InterventionsNot applicable. Main Outcome MeasuresRecommended and delivered wheelchair equipment type and length of time between recommendation and delivery. ResultsDifferences were found between the recommended and delivered equipment in manual wheelchairs, power mobility devices, seat backs, cushions, and power option equipment groups (P≤.001). Delivered manual wheelchairs were 7% more likely to be different than the recommendation for each year decrease in age (P≤.001), although the model lacked sufficient predictive accuracy for clinical application. The average length of time from equipment recommendation to delivery was about 6 months (mean, 176d). Standard and complex power mobility devices were associated with longer timelines (median, 137d and 173d, respectively; P=.001), although only complex power mobility device timelines were significantly associated with public funding sources (P=.02). ConclusionsWheelchair bases, positioning accessories, and power options may be delivered differently than originally recommended, and the process for procuring complex power mobility devices with public funding sources should be studied further. Health care professionals should consistently follow up on delivered equipment to ensure that expectations and needs of the wheelchair user are met. Reducing systemic barriers to interdisciplinary communication postrecommendation may improve patient outcomes.

Karyotype is associated with timing of ovarian failure in women with Turner syndrome

To characterize the age of ovarian failure in Turner Syndrome (TS) patients by karyotype. Retrospective cohort study of individuals with TS at an academic university hospital. Subjects were seen in TS Clinic at UNC Hospital between 2014 and 2018. Individuals were analyzed by karyotype category (45X, 45X/46XX mosaicism, miscellaneous) and percentage of 45X cells. Age at follicle-stimulating hormone> 30 was defined as the age at loss of ovarian function. A total of 79 patients were identified after excluding individuals with unknown ovarian function and those with Y chromosome material. Thirty-eight percent were 45X monosomic, 62% were 45X/46XX mosaic or miscellaneous karyotypes. Fifty-five of 79 (70%) patients had evidence of ovarian failure, median age of failure 11 years (IQR: 4,12). Ovarian failure was more prevalent among individuals with 45X karyotype (100%). The median age of ovarian failure for 45X patients (n=30) was 10 years old, which is significantly younger than other karyotypes (n=49), with a median of 15 years, p<0.01. Linear regression analysis found that 1 percentage point increase in 45X cells in the peripheral karyotype is associated with a 0.09 year decrease in age of ovarian failure (p value=0.01). Only 9% of individuals were referred for fertility counseling. There is a lower prevalence of ovarian failure among individuals with mosaic TS karyotypes, and referral rate for fertility counseling of patients with TS is low. These findings are in line with published literature. The finding that percentage of 45X cells in peripheral karyotype is associated with earlier age of ovarian failure is novel and warrants further investigation in a larger prospective cohort.

Age at menarche in Nigerian demographic surveys.

Age at menarche was investigated using data collected from demographic surveys (WFS, DHS) conducted in Nigeria between 1982 and 2018, all of which were based on large representative samples of the female population. Linear-logistic regressions were used to estimate mean age at menarche, its trends and its risk factors. Mean age at menarche had underwent a marked secular decline from 15.02 years for girls born in 1933 to 13.78 years for girls born in 2003. In multivariate analysis, height (stature), body mass index (BMI), level of education and household wealth had independent effects on age at menarche, whereas urban residence had no effect. Socioeconomic gradients were large: +9 years of schooling was associated with a -0.52 year decrease in age at menarche, and +2 standard deviations in household wealth with a -0.33 year decrease. The impact of anthropometry was even greater: +2 standard deviations in height was associated with a -0.99 year decrease in age at menarche, and +2 standard deviations in BMI with a -1.42 year decrease. Northern provinces had a higher mean age at menarche than southern provinces. Compared with independent sources, long-term trends in age at menarche, as well as their fluctuations, appeared to be correlated with trends and fluctuations in income per capita and in under-five mortality, but not with divergent trends in adult height.

The effects of age at menarche and first sexual intercourse on reproductive and behavioural outcomes: A Mendelian randomization study.

There is substantial variation in the timing of significant reproductive life events such as menarche and first sexual intercourse. Life history theory explains this variation as an adaptive response to an individual’s environment and it is important to examine how traits within life history strategies affect each other. Here we applied Mendelian randomization (MR) methods to investigate whether there is a causal effect of variation in age at menarche and age at first sexual intercourse (markers or results of exposure to early life adversity) on outcomes related to reproduction, education and risky behaviour in UK Biobank (N = 114 883–181 255). Our results suggest that earlier age at menarche affects some traits that characterize life history strategies including earlier age at first and last birth, decreased educational attainment, and decreased age at leaving education (for example, we found evidence for a 0.26 year decrease in age at first birth per year decrease in age at menarche, 95% confidence interval: -0.34 to -0.17; p < 0.001). We find no clear evidence of effects of age at menarche on other outcomes, such as risk taking behaviour. Age at first sexual intercourse was also related to many life history outcomes, although there was evidence of horizontal pleiotropy which violates an assumption of MR and we therefore cannot infer causality from this analysis. Taken together, these results highlight how MR can be applied to test predictions of life history theory and to better understand determinants of health and social behaviour.

Early puberty and risk for type 2 diabetes in men

Aims/hypothesisThe association between pubertal timing and type 2 diabetes, independent of prepubertal BMI, is not fully understood. The aim of the present study was to evaluate the association between pubertal timing and risk of adult type 2 diabetes, independent of prepubertal BMI, in Swedish men.MethodsWe included 30,697 men who had data for BMI at age 8 and 20 years and age at Peak Height Velocity (PHV), an objective assessment of pubertal timing, available from the BMI Epidemiology Study Gothenburg (BEST Gothenburg), Sweden. Information on type 2 diabetes (n = 1851) was retrieved from the Swedish National Patient Register. HRs and 95% CIs were estimated by Cox regression analysis. We observed violations of the assumption of proportional hazards for the association between age at PHV and the risk of type 2 diabetes and therefore split the follow-up period at the median age of type 2 diabetes diagnosis (57.2 years of age) to define early (≤57.2 years) and late (>57.2 years) type 2 diabetes diagnosis.ResultsAge at PHV was inversely associated with both early (HR 1.28 per year decrease in age at PHV, 95% CI 1.21, 1.36) and late (HR 1.13, 95% CI 1.06, 1.19) type 2 diabetes. After adjustment for childhood BMI, the associations between age at PHV and both early (HR 1.24, 95% CI 1.17, 1.31) and late (HR 1.11, 95% CI 1.05, 1.17) type 2 diabetes were similar. Moreover, early age at PHV predicted insulin treatment of type 2 diabetes (OR 1.25 per year decrease in age at PHV, 95% CI 1.17, 1.33). Assuming a higher risk among those with an age at PHV below the median, the population attributable factor indicates that 15% fewer of the diagnosed individuals would have developed type 2 diabetes had they not reached puberty early.Conclusions/interpretationThese findings indicate that early puberty may be a novel independent risk factor for type 2 diabetes.

Relationship between Vitamin D Deficiency, Diabetes, and Obesity

AimThis study aimed to assess the prevalence of VDD in Saudi Arabia, revealing the lifestyle and nutritional habits; and assesses the association between VDD, Diabetes Mellitus, and obesity. MethodsA descriptive, cross-sectional, and correlational design was used in this study. A convenience sampling method of 350 participants participated in the study. ResultsThe results revealed that the probability of having vitamin D Deficiency was higher among females (OR = 2.06, p > .05); younger age-whereby with each one year decrease in age there was about 0.03 probability of having Vitamin D Deficiency (B = −0.03; p > .05); individuals with higher incomes (OR = 1.44, p > .05); smokers (OR = 0.08, p > .05); and a lack of exposure to the sun (OR = 8.50; p > .05). In addition, exercise is also a predictor of Vitamin D deficiency (OR = 3.8; p > .05). Moreover, less Vitamin D intake (OR 9.7; p > .05), less intake of Calcium (OR = 12.2, p > .05); In addition increase one unit in the BMI, cholesterol, LDL, HDL, and FBS increased the log odd of having liability of Vitamin D deficiency by 3.2; 1.9, 1.8, 1.0, and 2.4 (p > .05). ConclusionVitamin D Deficiency was prevalent in both males and females across different age groups in the citizens of Saudi. Because of the connection between Vitamin D Deficiency and main chronic disease, it is necessary to emphasize the need to recognize Vitamin D Deficiency screening for risk factors. It may be reasonable for the nutritionists, nurses, and physicians, to encourage the community on approaches to enhance dietary Vitamin D or suggest supplementation.

Abstract 4250: Molecular alterations in the breast associated with early menarche

Abstract Background: Menarche, the onset of the female menstruation, is a marker of pubertal timing. Age at menarche varies widely between girls and is highly dependent on nutritional status and body fat accumulation. The occurrence of menarche at an early age is linked to an increased risk of several adverse health conditions later in life, such as obesity, type-2 diabetes, breast and endometrial cancer, and cardiovascular disease. Indeed, for every one year decrease in age at menarche (from an average age at menarche of 12.5 years), breast cancer risk is increased by 5%. Several genome wide association studies (GWAS) have identified genetic variants (i.e. in the LIN28B gene) that are associated with early age at menarche, however little is known about the changes occurring in the breast tissue of women with early menarche. We hypothesize that early age at menarche results in permanent molecular alterations in the breast tissue and that those abnormalities may contribute to the tissue’s susceptibility to carcinogens and breast cancer development. Methods: To test our hypothesis we used the resources available at the Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center (KTB). We selected histologically normal breast tissue from healthy, young women with either early (age ≤ 10 years) or late menarche (age ≥ 15 years), and matched for age, race, BMI, and menstrual phase. Breast tissue biopsies from these women were microdissected to isolate the breast epithelium and next generation RNA-sequencing was used to generate a transcriptome profile for each sample. Differential expression was performed using DESeq2 in R. The tissue samples were also evaluated using immunostaining. Results/Conclusions: Preliminary data show significant differences when comparing the transcriptome profiles of the microdissected breast epithelium from the early and late menarche sample cohorts. The tissue from women with early menarche had upregulation of genes associated with defense against oxidative stress and/or infectious bacteria (lactotransferrin [LTF], ceruloplasmin [CP]), cell adhesion, (ITGα11, ITGαX, ITGαM, ITGαL, ITGβ2), immune response (CARD9, LAIR1), and had downregulation of ubiquitination pathways (USP40, AMFR) and lipoprotein metabolism (OSBPL1A, LIPH, PIGN). Immunohistochemical evaluation of markers of oxidative stress (LTF, CP), cell proliferation (Ki67), and immune infiltrates (CD45, CD20, CD8, CD68) is underway. Together, this information will give us the opportunity to better understand early age at menarche as a breast cancer risk factor and advance research for women’s health. Citation Format: Mariah L. Johnson, Natascia Marino, Anna Maria V. Storniolo, Bradley A. Hancock, Milan Radovich, George E. Sandusky. Molecular alterations in the breast associated with early menarche [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4250. doi:10.1158/1538-7445.AM2017-4250

Prevalence, subtypes, severity and determinants of ocular trauma: The Singapore Chinese Eye Study

PurposeTo describe the prevalence, subtypes, severity and determinants of ocular trauma (OT) in a population-based study in Singapore.MethodsWe included 3353 Chinese adults aged ≥40 years from the Singapore Chinese Eye...

Stratification of Allogeneic Hematopoietic Cell Transplant By Risk of Developing Veno-Occlusive Disease: A Model for Assigning a Risk Score

BackgroundHepatic veno-occlusive disease (VOD) is a rare complication of hematopoietic cell transplantation (HCT) that is associated with high mortality. Developing a clinical risk score to identify patients at high risk for VOD would inform clinical decision-making and aid efforts to study preventive strategies.MethodsWe retrospectively analyzed data on 13,097 patients receiving allogeneic HCT as reported by 221 centers to the Center for International Blood & Marrow Transplant Research between 2008-2013. All ages, disease types (malignant, non-malignant), and conditioning regimen intensities were included. The cohort was randomly divided into training and validation sets. The primary outcome was development of VOD by day+100 post HCT with or without multi-organ failure as reported by the reporting institutions. A multivariate logistic regression model was built using the training set to identify independent prognostic factors associated with the primary outcome. Age was analyzed as a continuous variable within 5 strata (Table 1). A risk score was constructed in the training set using the significant factors from the regression model: the magnitude of the odds ratios (OR) determined the magnitude of the risk score term coefficients. Risk scores were calculated by addition of the risk score coefficients corresponding to each patients’ characteristics. The score’s predictive ability was confirmed in the validation set.ResultsBaseline characteristics are shown in Table 1. The training and validation sets were similar across all characteristics. VOD incidence at day+100 was 4.9% (n=637). VOD diagnosis was established by biopsy/autopsy (n=139), Seattle criteria (n=115) or Baltimore criteria (n=289) in 543 patients (85% of patients). Diagnostic information was missing on 3 patients. The remaining 91 patients were diagnosed using other clinical evidence (e.g. ascites, ultrasound). The multivariate model identified 6 independent prognostic variables: age, hepatitis B/C (HBV/HCV) serology, Karnofsky performance score (KPS), disease type/status, conditioning regimen and sirolimus use. See Table 1 for non-significant variables assessed. Age was inversely associated with development of VOD across all strata; only the <10 and 20-40 strata were statistically significant (Figure 1). For ages <10 years, 10-20, 20-40, 40-60, and 60-80 the ORs were 1.10 (95% confidence interval [CI] 1.03-1.17, p=0.004), 1.01 (95% CI: 0.95 - 1.07, p=0.81), 1.04 (95% CI: 1.01-1.08, p=0.01), 1.01 (95% CI: 0.98-1.04, p=0.61), and 1.05 (95% CI: 0.96-1.15, p=0.28), corresponding to a 10%, 1%, 4%, 1% and 5% increased risk of VOD for each year decrease in age within their respective strata. Myeloablative (MAC) regimens were associated with higher risk of VOD, and busulfan-based (BU) MAC regimens guided by pharmacokinetic (PK) monitoring were associated with higher risk than those without PK guidance. KPS <90% (OR 1.47, 95% CI 1.11-1.95, p=0.007), HBV+ serology with or without HCV+ serology (OR 2.19, 95% CI 1.35-3.56, p=0.002), and use of prophylactic sirolimus (OR 2.39, 95% CI 1.54-3.71, p = 0.0001) were associated with higher risk. Within the training set, each patient’s risk score was calculated and the patients were stratified into 4 groups according to their risk score percentile: low (A, ≤40th percentile), intermediate (B, >40th, ≤80th percentile), high (C, >80th, ≤90th percentile) and very high risk (D, >90th percentile) with ORs for development of VOD in the training and validation sets as shown in Table 2 and Figures 2 and 3. The incidences of VOD within groups A, B, C and D in the training set were 1.15%, 4.34%, 8.70%, and 17.84%, respectively; the corresponding incidences in the validation set were 1.96%, 4.43%, 9.72%, and 14.33%, respectively. There was no significant difference in the c statistic by set (p = 0.07).ConclusionThe risk score successfully stratified allogeneic HCT patients by risk of developing VOD and was validated in an independent subset of patients. The model demonstrates strong discriminatory ability to identify a high risk cohort to focus efforts for further study. [Display omitted] [Display omitted] DisclosuresVilla:Jazz Pharmaceuticals: Employment, Equity Ownership.

Complex relation of HLA-DRB1*1501 , age at menarche, and age at multiple sclerosis onset

Objective:To examine the relationship between 2 markers of early multiple sclerosis (MS) onset, 1 genetic (HLA-DRB1*1501) and 1 experiential (early menarche), in 2 cohorts.Methods:We included 540 white women with MS or clinically isolated syndrome (N = 156 with genetic data available) and 1,390 white women without MS but with a first-degree relative with MS (Genes and Environment in Multiple Sclerosis [GEMS]). Age at menarche, HLA-DRB1*1501 status, and age at MS onset were analyzed.Results:In both cohorts, participants with at least 1 HLA-DRB1*1501 allele had a later age at menarche than did participants with no risk alleles (MS: mean difference = 0.49, 95% confidence interval [CI] = [0.03–0.95], p = 0.036; GEMS: mean difference = 0.159, 95% CI = [0.012–0.305], p = 0.034). This association remained after we adjusted for body mass index at age 18 (available in GEMS) and for other MS risk alleles, as well as a single nucleotide polymorphism near the HLA-A region previously associated with age of menarche (available in MS cohort). Confirming previously reported associations, in our MS cohort, every year decrease in age at menarche was associated with a 0.65-year earlier MS onset (95% CI = [0.07–1.22], p = 0.027, N = 540). Earlier MS onset was also found in individuals with at least 1 HLA-DRB1*1501 risk allele (mean difference = −3.40 years, 95% CI = [−6.42 to −0.37], p = 0.028, N = 156).Conclusions:In 2 cohorts, a genetic marker for earlier MS onset (HLA-DRB1*1501) was inversely related to earlier menarche, an experiential marker for earlier symptom onset. This finding warrants broader investigations into the association between the HLA region and hormonal regulation in determining the onset of autoimmune disease.

Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

Intended and unintended pregnancies occur frequently among human immunodeficiency virus (HIV)-infected women. We evaluated the occurrence of repeat pregnancy and characteristics associated with this outcome among HIV-infected women in Latin America and the Caribbean who were participating in the National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI). Of the 1342 HIV-infected pregnant women enrolled in NISDI, 124 (9.2%) had one or more repeat pregnancies on study. Median time between the index delivery and date of conception of the subsequent pregnancy was 1.4 years (range 0.1–5.7). Younger age (odds ratio [OR] = 1.07, 95% confidence interval [CI]: 1.04–1.11 per one year decrease in age), hospitalization during the index pregnancy or up to six months post-partum [OR = 2.0, 95% CI: 1.2–3.4], and poor index pregnancy outcome (stillbirth or spontaneous/therapeutic abortion; OR = 3.4, 95% CI: 1.4–8.4) were associated with increased occurrence of repeat pregnancy in multivariable analysis. Among women with repeat pregnancies, the proportion receiving antiretroviral treatment (vs. prophylaxis) increased from 39.4% at the time of the index pregnancy to 81.8% at the time of the repeat pregnancy (p < 0.001). These results can help identify women most likely to benefit from reproductive counseling in order to assist with healthy pregnancy planning and prevention of unintended pregnancies.

Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study.

BackgroundIdentification of prognostic factors for persistent pain and disability are important for better understanding of the clinical course of chronic unilateral lumbar radiculopathy and to assist clinical decision-making. There is a lack of scientific evidence concerning prognostic factors. The aim of this study was to identify clinically relevant predictors for outcome at 52 weeks.Methods116 patients were included in a sham controlled clinical trial on epidural injection of glucocorticoids in patients with chronic unilateral lumbar radiculopathy. Success at follow-up was ≤17.5 for visual analogue scale (VAS) leg pain, ≤22.5 for VAS back pain and ≤20 for Oswestry Disability Index (ODI). Fifteen clinically relevant variables included demographic, psychosocial, clinical and radiological data and were analysed using a logistic multivariable regression analysis.ResultsAt follow-up, 75 (64.7%) patients had reached a successful outcome with an ODI score ≤20, 54 (46.6%) with a VAS leg pain score ≤17.5, and 47 (40.5%) with a VAS back pain score ≤22.5.Lower age (OR 0.94 (CI 0.89–0.99) for each year decrease in age) and FABQ Work ≥34 (OR 0.16 (CI 0.04-0.61)) were independent variables predicting a successful outcome on the ODI.Higher education (OR 5.77 (CI 1.46–22.87)) and working full-time (OR 2.70 (CI 1.02–7.18)) were statistically significant (P <0.05) independent predictors for successful outcome (VAS score ≤17.5) on the measure of leg pain. Lower age predicted success on ODI (OR 0.94 (95% CI 0.89 to 0.99) for each year) and less back pain (OR 0.94 (0.90 to 0.99)), while higher education (OR 5.77 (1.46 to 22.87)), working full-time (OR 2.70 (1.02 to 7.18)) and muscle weakness at baseline (OR 4.11 (1.24 to 13.61) predicted less leg pain, and reflex impairment at baseline predicted the contrary (OR 0.39 (0.15 to 0.97)).ConclusionsLower age, higher education, working full-time and low fear avoidance beliefs each predict a better outcome of chronic unilateral lumbar radiculopathy. Specifically, lower age and low fear avoidance predict a better functional outcome and less back pain, while higher education and working full-time predict less leg pain. These results should be validated in further studies before being used to inform patients.Trial registrationCurrent Controlled Trials ISRCTN12574253. Registered 18 May 2005.

1240 ACUTE ON CHRONIC PEYRONIE'S DISEASE: PATIENT PROFILES AND PREDICTORS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation (I)1 Apr 20131240 ACUTE ON CHRONIC PEYRONIE'S DISEASE: PATIENT PROFILES AND PREDICTORS Patrick Teloken, Boback Berookhim, Judy Choi, Byron Alex, Campbell Bryson, Asha Jamzadeh, and John Mulhall Patrick TelokenPatrick Teloken New York, NY More articles by this author , Boback BerookhimBoback Berookhim New York, NY More articles by this author , Judy ChoiJudy Choi New York, NY More articles by this author , Byron AlexByron Alex New York, NY More articles by this author , Campbell BrysonCampbell Bryson New York, NY More articles by this author , Asha JamzadehAsha Jamzadeh New York, NY More articles by this author , and John MulhallJohn Mulhall New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2593AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The natural history of Peyronie's disease (PD) has been outlined. Conventional wisdom states that the condition becomes stable by 18 months after commencement. Clinical experience informs us that some men stabilize and then recur with a change in deformity after a prolonged period of stability. This analysis was undertaken to define this population of men with PD. METHODS We reviewed our prospectively constructed PD database of patients enrolled between 2002-2006 with at least 2 years of follow up after the point of stabilization. Stability was defined by (i) >3 months of no deformity change and (ii) PD for >18 months in duration and (iii) a non-tender plaque. Acute on chronic PD was diagnosed when patients during follow-up interview reported change or worsening of deformity. All such patients underwent deformity assessment (DA) with intracavernosal injection assistance. Demographic, comorbidity and PD factors were recorded. Patients who underwent penile implant surgery after PD diagnosis were excluded. Multivariable analysis was conducted to define predictors of recurrence of PD. Factors included in the model included: age, diabetes, magnitude of primary curvature, presence of hourglass deformity, trauma history. RESULTS A total of 1092 stable patients were identified; 724 had ≥12 months and 384 ≥24 months follow-up after stabilization. Of these 660 (91%) and 302 (78.6%) were sexually active and had erections firm enough for intercourse (with or without erectile aids). At 12 months, 26/660 (3.9%) complained of worsening deformity however on DA only 16 (2.4%) had proven change in deformity. At 24 months, of the 286 who did not have deformity change by 12 months, 11 (3.9%) complained of worsening deformity. However on DA only 5 (1.7%) had proven change in deformity. For the 21 patients with documented deformity change, 15 changed magnitude, 3 changed direction alone, and 3 changed direction and magnitude. Mean change for those who recurred was 13±11 (range 10-28) degrees. On multivariable analysis, only patient age was a predictor of recurrence: <45 years of age at PD diagnosis (OR 4.5, 2.8-11.2, p<0.001), 10 year decrease in age (OR 2.2, 1.2-6.0, p<0.01). CONCLUSIONS We report on the rare but important finding that some men will develop acute on chronic PD after stabilization of their disease. Only 50% of patients who complain of worsening deformity will have such finding confirmed on DA. This entity is most likely to occur in younger men. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e507 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Teloken New York, NY More articles by this author Boback Berookhim New York, NY More articles by this author Judy Choi New York, NY More articles by this author Byron Alex New York, NY More articles by this author Campbell Bryson New York, NY More articles by this author Asha Jamzadeh New York, NY More articles by this author John Mulhall New York, NY More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Breast cancer susceptibility loci in association with age at menarche, age at natural menopause and the reproductive lifespan

Abstract Purpose: Genome wide association studies have identified common single nucleotide polymorphisms (SNPs) associated with breast cancer risk. Many of these SNPs have an unknown biologic significance. Hormonal risk factors may mediate the relationships between these loci and breast cancer risk. We explored the relation between breast cancer susceptibility loci and menstrual factors using data from two population-based studies. Methods: In the first dataset, composed of 1328 women ages 20–74 years without a breast cancer diagnosis who participated in an established population-based study conducted in three U.S. states, we used linear regression to assess the associations between 13 previously-identified breast cancer loci with age at menarche, age at natural menopause and the reproductive lifespan. The reproductive lifespan is defined as the time between age at menarche and age at natural menopause, excluding time for pregnancy, oral contraceptive use and lactation. A polygenic risk score created as the sum of the number of risk allele copies in the SNPs was also evaluated for an association with menstrual traits. Significant results were then evaluated in the second dataset comprised of 1353 women ages 43–86 years recruited as part of a cohort study based in Beaver Dam, WI. Results: Polygenic score and 13 loci were not associated with either age at menarche or reproductive lifespan. Two SNPs were associated with age at natural menopause; each increase in the number of copies of the minor allele (A) of rs17468277 (CASP8) was associated with a 1.12 year decrease in age at natural menopause (p = 0.02). The minor allele (G) of SNP rs10941679 (5p12) (p = 0.01) was associated with a 1.01 year increase in age at natural menopause, although these results were not replicated in the follow-up study (p = 0.14 and 0.98, respectively). Conclusions: We did not find evidence to support the hypothesis that breast cancer susceptibility loci are related to menstrual factors.

The laryngeal mask airway for pediatric adenotonsillectomy: Predictors of failure and complications

ObjectivesWe hypothesize that the laryngeal mask airway (LMA) is a safe technique for airway management in pediatric adenotonsillectomy (T&A). MethodsAfter institutional review board (I.R.B.) approval, we conducted a retrospective review of 1199 medical records of children who underwent T&A from 2002 to 2006 at Doernbecher Children's Hospital, a teaching institution in Portland, OR. There were no significant demographic differences between the LMA (n=451), endotracheal tube (ETT) (n=715), and failed LMA groups (n=33). Outcome variables were LMA failure (LMA replaced with endotracheal tube), and any complication. We collected demographic and medical data to determine the incidence and predictors of LMA failure, and to characterize the failed LMA group. ResultsThe incidence of LMA failure was 6.8%. Patients who underwent adenoidectomy had significantly lower odds of LMA failure compared to patients who had a tonsillectomy or adenotonsillectomy (OR 0.28, 95% CI 0.15–0.52, P<0.0001). One of the surgeons (OR 0.46, 95% CI 0.45–0.48, P<0.0001) was also associated with decreased odds of LMA failure. Controlled ventilation (OR 7.17, 95% CI 4.99–10.32, P<0.0001), and younger patients (OR 1.05 for each year decrease in age, 95% CI 1.03–1.07, P≤0.0001) were associated with increased odds of LMA failure.The complication rate was 14.2% in the LMA group and 7.7% in the ETT group.Increased odds of developing any complication were seen in male patients (OR 1.4, 95% CI 1.01–1.7, P=0.04), and in patients with co-morbidities other than obstructive sleep apnea syndrome or upper respiratory tract infection (OR 4.2, 95% CI 1.03–17.2, P=0.04). The odds of developing a complication were lower in the ETT group compared to the LMA group (0.63, 0.46, 0.8, P=0.005). ConclusionsLMA use for pediatric T&A is associated with a higher incidence of complications, mainly as a result of airway obstruction following insertion of the LMA or McIvor gag placement. Complications were more likely if tonsillectomy was performed when compared to adenoidectomy alone. Appropriate patient selection, careful insertion, and avoidance of controlled ventilation may decrease the incidence of LMA failure, especially if tonsillectomy is performed. The ability of surgeons to work around the LMA can modify the failure rate significantly.

Chlamydia trachomatis re-infections in a population-based cohort of women

ObjectivesRe-infection with chlamydia may increase subsequent reproductive morbidity in women. The authors sought to identify characteristics associated with re-infection.MethodsA cohort of all women aged 10–49 years with a notification of...

Comparative Assessment of Significant Psychological Distress In Patients with Malignant and Non-Malignant Hematologic Disorders

AbstractAbstract 1538 Background:Several measurement tools for distress have been extensively evaluated in patients with solid tumor malignancies and are useful in various stages of treatment, but none have been consistently incorporated into clinical care for hematology patients. The degree of distress in patients with hematologic disease, both malignant and non-malignant is under-investigated, and comparisons of stress levels of patients with malignant and non-malignant blood disorders are infrequent. Aim:To asses and compare distress in patients with malignant and non-malignant hematological disorders at a multidisciplinary community-based hematology/oncology clinic. Methods:Consecutive adult malignant and non-malignant hematology patients (n=617) seen at the Gundersen Lutheran Center for Cancer and Blood Disorders were prospectively enrolled over a 6 month period. Patients were excluded for incomplete surveys. Study patients completed a prospective survey that included the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT; scale of 0–10) and the modified NCCN problem list at the first clinic visit and all subsequent visits throughout the study period. All prospective surveys were completed prior to each clinic appointment. Additional demographics including diagnosis and disease related information were collected by chart review. A distress score ≥ 5 was used an indicator of distress. Results:A total of 572 patients met study criteria (mean age 62.4±17.4 yrs; 49% men; 56% non-malignant hematologic disorders). The mean DT stress number for the cohort was 3.4±2.7, with 36% rating distress ≥5. Univariate logistic regression analysis revealed younger age (OR:1.33, CI:1.20-1.47;p=0.001, per 10 year decrease in age), history of depression and/or anxiety (OR:3.14, CI:2.20-4.48;p=0.001), female gender (OR:2.23, CI:1.62-3.27;p=0.001), non-malignant disease state (OR:1.51, CI:1.06-2.14;p=0.022) and unmarried (OR:1.70, CI:1.18-2.46;p=0.005) were all associated with a distress score ≥5. The timing of patients' first visit to hematology clinic was also associated with a distress score ≥5, with patients filling out the DT and problems list within 30 days of their first hematology visit more likely to rate distress ≥5 (OR:1.92, CI:1.21-3.04; p=0.008 compared to patients more than 1 year). All but non-malignant disease state remained associated with a distress score ≥5 in a multivariate analysis (Table 1). Further analysis for the subgroup of disease state (non-malignant vs malignant) revealed that subjects with non-malignant diagnoses were younger (61.1 vs 64.1 yrs; p=0.040), largely female (60% vs 40%; p=0.001), had greater history of depression and/or anxiety (47% vs 38%; p=0.035) and less likely to be married (66% vs 75%; p=0.013). Conclusion:Distress levels of >5 on the DT were significantly more likely to occur in patients who were seen within the first 30 day of presentation, women, younger patients, those with previous depression/anxiety, and those who are unmarried. On multivariate analysis the diagnosis of malignant or non-malignant hematologic disorder did not predict DT levels >5. Based on these results, patients with malignant as well as non-malignant hematologic disorders with these risk factors should be considered for distress screening and management. Disclosures:No relevant conflicts of interest to declare.

A Diagnostic Predictor Model for Indeterminate or Suspicious Thyroid FNA Samples

The management of patients with thyroid fine-needle aspiration (FNA) specimens that are neither benign nor malignant still remains problematic. Efforts to improve their management have focused on identifying risk factors that predict malignancy. This study seeks to identify clinical and tumor characteristics that predict thyroid malignancy among patients with indeterminate or suspicious FNA and to develop a diagnostic predictor model. The records of 639 patients with an indeterminate or suspicious thyroid FNA between January 1995 and April 2005 were reviewed. Patient and tumor characteristics were evaluated for their potential to predict malignancy in the final surgical histopathology. A diagnostic predictor model was designed based on statistically significant predictors. Patients seen between April 2005 and April 2007 were used to validate the model. Patient age, nodule size, and FNA cytopathology were identified as risk factors. Patients at extremes of age were at increased risk. Patients 50 years of age had the lowest risk of malignancy. For patients less than age 50, the risk increased 3% for each year decrease in age (p = 0.001). After 50, the risk increased 3.4% for each year increase in age (p = 0.016). Nodules 2.5 cm had the lowest likelihood of malignancy. For smaller nodules, the risk increased 53% per cm decrease in size (p < 0.001). For larger nodules, the risk increased 39% per cm increase (p < 0.001). Patients with FNA cytology suspicious for papillary thyroid carcinoma had the greatest risk of malignancy (p < 0.001). A predictor model was created using the variables age, nodule size, and FNA cytology to predict thyroid malignancy.

Analysis of a staging assessment system for prediction of surgical interval in recurrent respiratory papillomatosis

A staging system for assessment of recurrent respiratory papillomatosis (RRP) has been in use over the last 3 years for 17 patients at our children's hospital. To evaluate a staging system for assessment of RRP on the basis of the predictive value on the surgical interval of: anatomic staging system score, urgency of intervention, voice quality, and stridor. To assess effect on surgical interval of the age of patient at time of surgery and use of adjuvant therapy. To develop a model based on the staging criteria to predict need for adjuvant therapy. Validation cohort. Academic children's hospital. Estimated time to surgery decreased by "x days": "independent variable" "(95% CI)" as follows. Four days: each 1 point in total anatomical score (0.2, 8); 120 days: total anatomical score >20 (37,203); 143 days: urgent versus scheduled surgery (42, 243); 100 days: aphonic versus normal voice (-211, 343); 31 days: abnormal versus normal voice (-281, 343); 125 days: stridor at rest versus no stridor (-31, 281); 109 days: stridor with activity versus no stridor (19, 198); 26 days: each 1 year decrease in age (22, 30). Adjuvant therapy delays next surgery by 32 days (-4, 69) and average scores decreased while on adjuvant therapy. Elements of our proposed staging system are effective in prediction of surgical interval with statistical significance achieved for total anatomical scores, urgency of intervention and stridor with activity versus no stridor. This study is pilot in nature and provides a framework upon which future studies can be based. The analysis of a larger, more severity diverse population could yield results which lead to a model capable of effectively predicting future surgical interval based on a weighted prediction score calculated from age, comorbidities, anatomic staging score, and clinical staging score.