Adrenalectomy for the treatment of hypotension in a cat with phaeochromocytoma associated with caudal vena cava syndrome

An 11-year-old spayed female, Persian cat was referred to the Jeonbuk Animal Medical Center for evaluation of a 2-month history of lethargy and anorexia. Physical examination revealed tachycardia and hypotension. Abdominal imaging via sonography and CT identified a right adrenal gland mass causing severe deviation and compression of the caudal vena cava. After stabilising the blood pressure and heart rate through positive inotropes and fluid therapy, right adrenalectomy was performed. Surgery confirmed the adrenal gland mass was severely compressing the caudal vena cava. Histopathological examination revealed that the mass was a pheochromocytoma. After adrenalectomy, blood pressure and heart rate stabilised and remained unaffected 8 months postsurgery. This report describes a rare case of an adrenal pheochromocytoma leading to caudal vena cava compression in a cat presenting with hypotension.

Accuracy of artificial intelligence-assisted growth prediction in skeletal Class I preadolescent patients using serial lateral cephalograms for a 2-year growth interval

OBJECTIVE

To investigate the accuracy of artificial intelligence-assisted growth prediction using a convolutional neural network (CNN) algorithm and longitudinal lateral cephalograms (Lat-cephs).

MATERIALS AND METHODS

A total of 198 Japanese preadolescent children, who had skeletal Class I malocclusion and whose Lat-cephs were available at age 8 years (T0) and 10 years (T1), were allocated into the training, validation, and test phases (n = 161, n = 17, n = 20). Orthodontists and the CNN model identified 28 hard-tissue landmarks (HTL) and 19 soft-tissue landmarks (STL). The mean prediction error values were defined as 'excellent,' 'very good,' 'good,' 'acceptable,' and 'unsatisfactory' (criteria: 0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm, respectively). The degree of accurate prediction percentage (APP) was defined as 'very high,' 'high,' 'medium,' and 'low' (criteria: 90%, 70%, and 50%, respectively) according to the percentage of subjects that showed the error range within 1.5 mm.

RESULTS

All HTLs showed acceptable-to-excellent mean PE values, while the STLs Pog', Gn', and Me' showed unsatisfactory values, and the rest showed good-to-acceptable values. Regarding the degree of APP, HTLs Ba, ramus posterior, Pm, Pog, B-point, Me, and mandibular first molar root apex exhibited low APPs. The STLs labrale superius, lower embrasure, lower lip, point of lower profile, B', Pog,' Gn' and Me' also exhibited low APPs. The remainder of HTLs and STLs showed medium-to-very high APPs.

CONCLUSION

Despite the possibility of using the CNN model to predict growth, further studies are needed to improve the prediction accuracy in HTLs and STLs of the chin area.

Racial Difference in Outcomes in Breast Cancer Patients with Residual Nodal Disease after Neoadjuvant Chemotherapy

PURPOSE/OBJECTIVE(S)

African Americans (AA) requiring neoadjuvant chemotherapy (NAC) have been associated with worse outcomes. Residual nodal disease (ypN+) after NAC represents a highly unfavorable risk factor. We hypothesized that even within this unfavorable subgroup, that racial differences in outcome would persist.

MATERIALS/METHODS

An IRB-approved retrospective review of breast cancer (BC) patients in a multi-institutional study was performed between 2005-2018 to identify ypN+ patients (excluding metastatic or inflammatory BC). Clinico-pathologic parameters stratified by race were collected and analyzed. For molecular subtype analyses, patients were stratified into triple negative (TN), hormone receptor (HR)+/HER2-, and HR+/HER2+, and HR-/HER2+ subtypes. Overall survival (OS), disease free survival (DFS) and recurrence outcomes were obtained, and univariate and multivariate (MVA) logistic regression models were constructed and analyzed.

RESULTS

Among 404 ypN+ patients, 107 (26%) were AA, and 297 (74%) were non-AA. Median follow-up for the non-AA group was 3.8 years (y) (IQR 2.4-6.3) and 3.5y (IQR 2.0-6.2) for the AA group. Clinical and pathologic patient characteristics (age, molecular subtypes, BRCA status, histology, grade, smoking status, primary surgery type, axillary/reconstruction surgery rates, margin status, stage) were without significant statistical differences between the non-AA and AA group, except the non-AA group had proportionally more cN3 disease (10.5% vs. 5.1%; p = .01). Despite this, AA demonstrated worse OS and DFS outcomes (Table). AA also had significantly worse local (15% vs. 6.7%, p = .02), regional (11.2% vs. 5.1%, p = .05) and distant recurrences (32.7% vs. 22.6%, p = .05) compared to non-AA. On MVA for OS and DFS, HR+ status, clinical stage, and AA race (HR 2.1 (CI 1.3-3.4), p = .004 and HR 1.7 (CI 1.1-2.6), p = .01 respectively) remained significant. Molecular subtype analysis demonstrated that AA with HR+/HER2- but not the TN subtypes demonstrated significantly worse outcomes (Table). Utilization of endocrine therapy was not different between AA and non-AA patients (94% vs. 97%, p = 0.3) to explain this discrepancy. Worse outcomes in HER2 subtype for AA group was suggested but could not be statistically verified due to insufficient sample size. There was no discernible difference in chemotherapy and radiation therapy regimen or compliance between the AA and non-AA groups.

CONCLUSION

AA patients who fail to achieve nodal clearance with NAC had higher local, regional and distant recurrence, and worse survival compared to non-AA, particularly those with non-TN status. These differences could not be readily explained by therapeutic disparity, or compliance. These hypothesis generating findings suggest need to explore biological implications, and alternative therapeutic strategies for this unfavorable subgroup.

Multi-Institutional Phase II Trial Using Dose Escalated Five Fraction Stereotactic Partial Breast Irradiation (S-PBI) with GammaPodTM for Early-Stage Breast Cancer

PURPOSE/OBJECTIVE(S)

We report on our early experience of a multi-institutional phase II study of dose escalated five fraction stereotactic partial breast irradiation (S-PBI) for early-stage breast cancer after partial mastectomy using the GammaPodTM stereotactic radiation system.

MATERIALS/METHODS

Patient eligibility included DCIS or invasive epithelial histologies, AJCC clinical stage 0, I, or II with tumor size < 3 cm, and negative margins. Prior safety of Phase I dose escalation has been reported. Dose was 40 Gy delivered in 5 fractions to the CTV, and minimum dose 30 Gy in 5 fractions to the PTV. CTV margin was 1 cm and PTV margin 3 mm. For PTV cavities larger than 100cc, dose was reduced to 35Gy in 5 fractions to the CTV and 30 Gy in 5 fractions to the PTV. Primary endpoint of the study is to determine the 3-year patient global cosmesis score (4-point scale excellent, good, fair, or poor) and adverse cosmesis using a dose escalated approach with smaller PTV margins than conventional methods. Both patients and physicians completed baseline and subsequent cosmesis outcome questionnaires. Treatment related toxicity was graded using the NCI version 4.0 and RTOG/EORTC late radiation scale.

RESULTS

From 3/2019-10/2021, 74 patients were treated respectively. Of these, 38 were treated to 40Gy and 36 were treated to 35 Gy. Median follow up (f/u) was 24 months (mo), range (r) 3-39mo. Median age was 63 years (r 43-77). Histology included 28 DCIS, and 46 invasive carcinomas. 45/46 invasive tumors were ER+. 60/74 (81%) patients received endocrine therapy, and 7/74 patient received chemotherapy. There were 221 acute grade 1 toxicities, and 28 Grade 2 toxicities. No grade 3 or higher acute toxicities were reported (< 90 days). The most common Grade 2 toxicities were radiation dermatitis (10), breast pain (8), blister (4), skin infection (2), nipple discharge (2), and fatigue (2). In the late period, there were 54 Grade 1 late toxicities, 4 Grade 2 late toxicities, and no Grade 3 or higher late toxicities. Grade 2 toxicities included fibrosis (2), and pain (2). Two patients developed grade 1 asymptomatic nonpalpable fat necrosis both diagnosed at 12 months after radiation treatments. The most common grade 1 late toxicities were breast pain (14), hyperpigmentation (8), fibrosis (10), and fatigue (5). Physicians scored cosmesis excellent or good 70/73 (95.8%), 58/60 (96.7%), 36/36 (100%),17/17(100%) respectively at baseline, 12 months, 24 months, and 36months post SBRT, while patients scored the same periods 62/71 (83.7%), 53/59 (89.8%), 33/36 (91.6%), 17/18 (94.4%). There have been no reports of disease recurrences.

CONCLUSION

Results at 24-month median follow-up, of our dose escalated stereotactic partial breast 5 fraction regimen, has low acute and late toxicity, while maintaining high proportion of excellent/good cosmetic outcomes. Continued analysis of all cohorts is in progress.

CLINICAL TRIALS

gov identifier is NCT03581136.

Assessment of Cardiac Radiation Dose in the Co-60 Prone Based Stereotactic Partial Breast Irradiation (CP-sPBI) Using the Distance from the Heart to the Planning Treatment Volume as a Surrogate Marker

PURPOSE/OBJECTIVE(S)

Irradiation of the breast has shown to provide sharp dose gradients using Co-60 prone based stereotactic partial breast irradiation (CP-sPBI), a contemporary device for stereotactic radiotherapy for breast cancer (BC) for accelerated partial breast irradiation (APBI). In addition, the precise setup of CP-sPBI permits a small planning treatment volume (PTV) margin of 3 mm creating a greater distance from PTV to organs at risk. However, to date the factors that influence dose gradients and subsequent cardiac doses of ionizing radiation using CP-sPBI have not been well-studied. Here we evaluate distance of the heart to the lumpectomy PTV cavity and how this effects cardiac dose.

MATERIALS/METHODS

A retrospective database of 113 consecutive patients treated by CP-sPBI for APBI from March 2019 to February 2023 who were treated with 30 Gy in 5 fractions were queried for analysis. The minimum distance from the heart to the PTV (hP) was measured in either the axial or sagittal view. A group of 28 patient cases were randomly selected to achieve an even distribution of 28 cases with hP < 2.75 cm and hP ≥ 2.75 cm to compare cardiac toxicities based on hP. Descriptive analyses were performed to evaluate various cardiac dosimetric parameters based on laterality of BC and hP, using the student's t test.

RESULTS

The mean (range) hP was 4.58 cm (0.80-12.23) for all cases. The subgroup analyses of 28 patient cases with cardiac parameters showed the heart mean (range) dose of 1.20 Gy (0.01-2.11). The mean and max heart dose to the left-sided BC were similar to those to the right-sided BC (mean dose: 1.20 vs. 1.19 Gy; P = 0.97 and max dose: 10.47 vs. 5.66 Gy; P = 0.06). An inverse correlation between hP and mean heart dose was shown with the correlation coefficient of -0.81. Using a cutoff of 2.75 cm hP, the differences between hP < 2.75 and hP ≥ 2.75 cm for all cardiac dosimetric evaluations were all statistically significant, including mean (1.67 vs. 0.79 Gy; p<0.01) and maximal heart dose (14.48 vs. 4.11 Gy; p<0.01) CONCLUSION: CP-sPBI treatment delivery system was able to achieve acceptable clinically relevant heart dosimetric parameters when delivering 5 fraction APBI with a mean heart dose of 1.20 Gy for all locations of PTV cavity volume in the breast. Due to CP-sPBIs excellent dose fall-off characteristics, APBI using CP-SPBI showed clinically acceptable cardiac dosimetric parameters, particularly for PTVs located > 2.75 cm from the heart.

Risk of Sexual Dysfunction in Men Treated with Pelvic Radiation Therapy for Locally Advanced Rectal Cancer: 20 Years of Experience with 451 Patients

PURPOSE/OBJECTIVE(S)

Radiation therapy (RT) is commonly used in the treatment of locally advanced rectal cancer (LARC), but data on its impact on men's sexual health is limited. Given the rising incidence of rectal cancer in younger men, sexual function is an important quality of life factor. We hypothesized that men with LARC treated with RT would be at increased risk of sexual dysfunction compared to men who did not receive RT.

MATERIALS/METHODS

This is a single institution retrospective analysis of outcomes of men ≤50 years diagnosed with LARC between 1999 and 2019. Primary outcomes of erectile dysfunction (ED), ejaculatory dysfunction (EjD), and testosterone deficiency (TD) were assessed via ICD-9/10 codes, and TD was captured with free testosterone <300 ng/dL. Cumulative incidences were calculated with death as a competing risk and p values were calculated using Gray's test. Subdistribution hazard ratios from competing risk regression models were used.

RESULTS

The combined study sample included 451 men: 347 received RT as part of their multimodality treatment, and 104 did not. Median time to last follow up was 5.6 years (IQR 3.3-8.7). Age at diagnosis, stage, and medical comorbidities for sexual dysfunction were similar between the two groups (p>0.05). Cumulative incidence estimates are shown in Table 1, showing a higher cumulative incidence of ED in the RT group, but no difference in EjD or TD between the 2 groups. On univariable analysis, RT, smoking, dyslipidemia, peripheral artery disease, depression, prostate cancer/hyperplasia, closed or current ileostomy, and undergoing rectal cancer surgery were all independent risk factors for ED (p<0.05). On multivariable analysis, RT maintained statistical significance as an independent risk factor for ED (HR 3.87, 95% CI 1.93-7.75, p<0.001). Within the RT group, IMRT compared to 3D (HR 1.54, 95% CI 1.02-2.32, p = 0.040) and groin RT (HR 2.60, 95% CI 1.21-5.59, p = 0.014) were independent risk factors for ED. Within the RT group, groin RT also approached significance as a risk factor for TD (HR 3.61, 95% CI 0.98-13.3, p = 0.054). No RT dose thresholds to external genitals or penile bulb were identified that increased risks of ED, EjD, or TD.

CONCLUSION

RT for LARC independently increases risk of ED but not EjD or TD. IMRT might increase the risk of ED due to increased scatter dose to the genitals and including the inguinal nodes in the target volumes increases the dose to the genitals/testicles, which could translate into a higher risk for ED and TD. Future research on proton RT and prophylactic sildenafil is needed in men ≤50 to decrease the risk of ED.

Financial Toxicity and Patient Experience Outcomes on a Multi-Institutional Phase I Single Fraction Stereotactic Partial Breast Irradiation Protocol for Early-Stage Breast Cancer

PURPOSE/OBJECTIVE(S)

Given the demonstrated financial toxicity (FT) of radiation treatment on breast cancer patients shown in both conventional and our recent 5 fraction stereotactic APBI (S-PBI) study, we assessed the FT, as well as patient-reported utility, quality-of-life and patient experience measures, on patients treated in our phase I single fraction S-PBI trial.

MATERIALS/METHODS

A phase I single fraction dose escalation trial of S-PBI for early-stage breast cancer was conducted. Women with in-situ or stage I-II (AJCC 6) invasive breast cancer following breast conserving surgery were treated with S-PBI in 1 fraction to a total dose of 22.5, 26.5 or 30 Gy (Clinical trials.gov ID NCT02685332). At one month follow-up, patients were asked to complete our novel "Patient Perspective Cost and Convenience of Care Questionnaire". Patients also completed the EQ-5D-5L, including the visual analogue scale of overall health (VAS), at enrollment, 6, 12-, 24-, 36-, and 48-month follow-up.

RESULTS

Of 29 patients enrolled and treated, questionnaire data was available for all patients. Our trial encompassed a wide range of annual household incomes, education, and employment status. Overall, 44.8% (n = 13/29) of patients reported that radiation treatment presented a financial burden. Interestingly, no demographic information, such as patient race, marital status, education, household income, or employment during treatment predicted perceived FT. Patients reporting FT trended towards younger age (median 64 vs 70.5) and having a cancer related co-pay similar to our 5 fraction S-PBI FT trial; however, due to the small size of this study, this did not reach significance (p = 0.24 and 0.10, respectively). VAS and utility scores were calculated per the EQ-5D-5L and remained unchanged from baseline through 4-year follow-up. Likewise, there was no difference in the utility or VAS between patients who reported FT and those who did not. Interestingly, while patient reported cosmesis was similar for all patients at enrollment, patients who reported FT noted significantly worse cosmesis scores (fair/poor vs good/excellent) at 6 month and 2-year follow-ups (p = 0.01 and 0.04, respectively). Finally, patients were surveyed on treatment related disruption to their daily activities and enjoyment of life. The median values were 0 (scale 0-10, with 0 being no disruption) regardless of perceived FT. Patients were also uniformly satisfied with treatment time with a median score of 10 (scale 0-10, 10 being most satisfied).

CONCLUSION

Here, we show that despite using SPBI in a single fraction, nearly half of the patients treated still reported FT of treatment. Importantly, single fraction S-PBI has no negative impact on patient VAS or utility scores, and all patients were uniformly satisfied with treatment time without significant disruption to their life.

Dosimetric Comparison of Adaptive Radiotherapy Modalities for Stereotactic Partial Breast Irradiation

PURPOSE/OBJECTIVE(S)

An increase in the availability of adaptive radiotherapy (ART) platforms have proven to be effective in the treatment of a variety of sites. In this study, we aim to evaluate the effectiveness of non-adaptive RT and 3 different ART platforms: (1) CBCT-based, (2) CT-based, and (3) MRI-based for stereotactic partial breast irradiation (SPBI).

MATERIALS/METHODS

Data were collected from 32 patients (16 left and 16 right breast) treated at a single institution. 16 patients (8 left and 8 right) treated using the non-ART platform were re-planned onto two different ART platforms, CBCT- and MRI-based. The remaining 16 patients treated using CT-based adaptive platform were not re-planned due to the prone patient treatment position (others systems supine). All cases were planned to 30 Gy in 5 fractions. Plan quality was evaluated based on pre-defined planning goals to the OARS: ipsilateral and contralateral lungs (Dmean, Dmax, V20 Gy, V9 Gy), ipsilateral (V15 Gy, V30 Gy) and contralateral breasts (Dmax), heart (Dmean, Dmax, V3 Gy, V1.5 Gy), skin (Dmax, V36.5 Gy), and rib (Dmax, V30 Gy). Target goals were defined by Dmax, Dmin, gradient index, and paddock conformality index. Re-planned cases were compared within the cohort using a paired t-test and a 2-sided t-test was used comparing to the CT-based platform.

RESULTS

Comparing the left and right breast cohort across all platforms, the CT-based ART system showed a signification dose reduction in Dmean (p<0.001 for all platforms), Dmax (p<0.001 for left breast, p<0.03 for right breast) and V9 Gy (p<0.004 for left breast, p<0.001 for right breast) to the ipsilateral lung, V15 Gy (p<0.004 for left breast cohort) to the ipsilateral breast, and Dmax to the contralateral breast (p<0.001) and ribs (p = 0.01, p<0.001, p = 0.01 for CBCT-ART, MRI-ART, and non-ART for left breast cohort only). On average, the MR-Linac platform showed the least degree of OAR sparing across nearly all dosimetric parameters evaluated when compared to all modalities, especially for contralateral lung Dmean and Dmax (p<0.05 for all dosimetric parameters for all platforms) and contralateral breast Dmax (p<0.003 for all platforms). The CBCT-based platform showed superior dose reduction in contralateral lung mean (p<0.03 for all platforms) and heart Dmean (p = 0.065, p<0.001, p = 0.045 for non-adaptive, MRI-ART, and CT-ART for left breast and p<0.008 for right breast). PTV coverage was comparable across all platforms, averaging at approximately 95%. The CT-based ART platform showed a significantly reduced gradient index relative to the CBCT- and MRI-based platforms (p<0.001).

CONCLUSION

For SPBI treatments, the CT-based ART platforms displayed a higher degree of OAR sparing for many of the dosimetric parameters recorded relative to the other ART and non-ART platforms presented. The MRI-based system typically showed less reduced OAR sparing; however, the advantage of the system is shown if soft tissue contrast is needed. PTV coverage remained comparable across all platforms.

OsCM regulates rice defence system in response to UV light supplemented with drought stress

Studies on plant responses to combined abiotic stresses are very limited, especially in major crop plants. The current study evaluated the response of chorismate mutase overexpressor (OxCM) rice line to combined UV light and drought stress. The experiments were conducted in pots in a growth chamber, and data were assessed for gene expression, antioxidant and hormone regulation, flavonoid accumulation, phenotypic variation, and amino acid accumulation. Wild-type (WT) rice had reduced the growth and vigour, while transgenic rice maintained growth and vigour under combined UV light and drought stress. ROS and lipid peroxidation analysis revealed that chorismate mutase (OsCM) reduced oxidative stress mediated by ROS scavenging and reduced lipid peroxidation. The combined stresses reduced biosynthesis of total flavonoids, kaempferol and quercetin in WT plants, but increased significantly in plants with OxCM. Phytohormone analysis showed that SA was reduced by 50% in WT and 73% in transgenic plants, while ABA was reduced by 22% in WT plants but increased to 129% in transgenic plants. Expression of chorismate mutase regulates phenylalanine biosynthesis, UV light and drought stress-responsive genes, e.g., phenylalanine ammonia lyase (OsPAL), dehydrin (OsDHN), dehydration-responsive element-binding (OsDREB), ras-related protein 7 (OsRab7), ultraviolet-B resistance 8 (OsUVR8), WRKY transcription factor 89 (OsWRKY89) and tryptophan synthase alpha chain (OsTSA). Moreover, OsCM also increases accumulation of free amino acids (aspartic acid, glutamic acid, leucine, tyrosine, phenylalanine and proline) and sodium (Na), potassium (K), and calcium (Ca) ions in response to the combined stresses. Together, these results suggest that chorismate mutase expression induces physiological, biochemical and molecular changes that enhance rice tolerance to combined UV light and drought stresses.

Improved Performance of Organic Thermoelectric Generators Through Interfacial Energetics

The interfacial energetics are known to play a crucial role in organic diodes, transistors, and sensors. Designing the metal-organic interface has been a tool to optimize the performance of organic (opto)electronic devices, but this is not reported for organic thermoelectrics. In this work, it is demonstrated that the electrical power of organic thermoelectric generators (OTEGs) is also strongly dependent on the metal-organic interfacial energetics. Without changing the thermoelectric figure of merit (ZT) of polythiophene-based conducting polymers, the generated power of an OTEG can vary by three orders of magnitude simply by tuning the work function of the metal contact to reach above 1000 µW cm^-2 . The effective Seebeck coefficient (S_eff ) of a metal/polymer/metal single leg OTEG includes an interfacial contribution (V_inter /ΔT) in addition to the intrinsic bulk Seebeck coefficient of the polythiophenes, such that S_eff  = S + V_inter /ΔT varies from 22.7 µV K^-1 [9.4 µV K^-1 ] with Al to 50.5 µV K^-1 [26.3 µV K^-1 ] with Pt for poly(3,4-ethylenedioxythiophene):p-toluenesulfonate [poly(3,4-ethylenedioxythiophene):poly(4-styrenesulfonate)]. Spectroscopic techniques are used to reveal a redox interfacial reaction affecting locally the doping level of the polymer at the vicinity of the metal-organic interface and conclude that the energetics at the metal-polymer interface provides a new strategy to enhance the performance of OTEGs.

Deep Learning of Time-Signal Intensity Curves from Dynamic Susceptibility Contrast Imaging Enables Tissue Labeling and Prediction of Survival in Glioblastoma

BACKGROUND AND PURPOSE

An autoencoder can learn representative time-signal intensity patterns to provide tissue heterogeneity measures using dynamic susceptibility contrast MR imaging. The aim of this study was to investigate whether such an autoencoder-based pattern analysis could provide interpretable tissue labeling and prognostic value in isocitrate dehydrogenase (IDH) wild-type glioblastoma.

MATERIALS AND METHODS

Preoperative dynamic susceptibility contrast MR images were obtained from 272 patients with IDH wild-type glioblastoma (training and validation, 183 and 89 patients, respectively). The autoencoder was applied to the dynamic susceptibility contrast MR imaging time-signal intensity curves of tumor and peritumoral areas. Representative perfusion patterns were defined by voxelwise K-means clustering using autoencoder latent features. Perfusion patterns were labeled by comparing parameters with anatomic reference tissues for baseline, signal drop, and percentage recovery. In the validation set (n = 89), a survival model was created from representative patterns and clinical predictors using Cox proportional hazard regression analysis, and its performance was calculated using the Harrell C-index.

RESULTS

Eighty-nine patients were enrolled. Five representative perfusion patterns were used to characterize tissues as high angiogenic tumor, low angiogenic/cellular tumor, perinecrotic lesion, infiltrated edema, and vasogenic edema. Of these, the low angiogenic/cellular tumor (hazard ratio, 2.18; P = .047) and infiltrated edema patterns (hazard ratio, 1.88; P = .009) in peritumoral areas showed significant prognostic value. The combined perfusion patterns and clinical predictors (C-index, 0.72) improved prognostication when added to clinical predictors (C-index, 0.55).

CONCLUSIONS

The autoencoder perfusion pattern analysis enabled tissue characterization of peritumoral areas, providing heterogeneity and dynamic information that may provide useful prognostic information in IDH wild-type glioblastoma.

Draft Genome Sequences of 27 Rhizogenic Agrobacterium Biovar 1 Strains, the Causative Agent of Hairy Root Disease

Rhizogenic Agrobacterium biovar 1 strains are important plant pathogens that cause hairy root disease in Cucurbitaceae and Solanaceae crops cultivated under hydroponic conditions. In contrast to tumorigenic agrobacteria, only a few genome sequences of rhizogenic agrobacteria are currently available. Here, we report the draft genome sequences of 27 rhizogenic Agrobacterium strains.

National trends in suicide-related behaviors among youths between 2005-2020, including COVID-19: a Korean representative survey of one million adolescents

OBJECTIVE

It is difficult to conclude that COVID-19 is associated with a decrease in the suicide attempts rate by comparing only a short-term period. Therefore, it is necessary to examine attempted suicide rates through a trend analysis over a longer period. This study aimed to investigate an estimated long-term trend regarding the prevalence of suicide-related behaviors among adolescents in South Korea from 2005 to 2020, including COVID-19.

SUBJECTS AND METHODS

We sourced data from a national representative survey (Korea Youth Risk Behavior Survey) and analyzed one million Korean adolescents aged 13 to 18 years (n=1,057,885) from 2005 to 2020. The 16-year trends regarding the prevalence of sadness or despair and suicidal ideation and attempt and the trend changes before and during COVID-19.

RESULTS

Data of 1,057,885 Korean adolescents was analyzed (weighted mean age, 15.03 years; males, 52.5%; females, 47.5%). Although the 16-year trend in the prevalence of sadness or despair and suicide ideation and attempt consistently decreased (prevalence of sadness or despair between 2005-2008, 38.0% with 95% confidence interval [CI], 37.7 to 38.4 vs. prevalence in 2020, 25.0% [24.5 to 25.6]; suicide ideation between 2005-2008, 21.9% [21.6 to 22.1] vs. prevalence in 2020, 10.7% [10.3 to 11.1]; and suicide attempt between 2005-2008, 5.0% [4.9 to 5.2] vs. prevalence in 2020, 1.9% [1.8 to 2.0]), the downward slope decreased during COVID-19 (βdiff in sadness, 0.215 with 95% CI 0.206 to 0.224; βdiff in suicidal ideation, 0.245 [0.234 to 0.256]; and βdiff in suicide attempt, 0.219 [0.201 to 0.237]) compared with pre-pandemic period.

CONCLUSIONS

This study found that the observed risk of suicide-related behaviors during the pandemic was higher than expected through long-term trend analysis of the prevalence of sadness/despair and suicidal ideation and attempts among South Korean adolescents. We need a profound epidemiologic study of the change in mental health due to the pandemic's impact and the establishment of prevention strategies for suicide ideation and attempt.

Safety of macitentan for the treatment of pulmonary hypertension: Real‐world experience from the OPsumit® USers Registry (OPUS) and OPsumit® Historical USers cohort (OrPHeUS)

Macitentan is an oral endothelin receptor antagonist for the management of pulmonary arterial hypertension (PAH). The OPsumit® USers Registry (OPUS) and the OPsumit® Historical USers cohort (OrPHeUS) medical chart review provide real‐world data for patients newly initiating macitentan. This study aims to describe the characteristics, safety profile, and clinical outcomes of PAH patients newly treated with macitentan in the combined OPUS/OrPHeUS data set. OPUS was a prospective, multicenter, long‐term, observational drug registry from April 2014 to June 2020. OrPHeUS was a retrospective, US, multicenter chart review: observation period October 2013 to March 2017. All analyses were descriptive. At registry closure in June 2020, the combined population consisted of 5654 patients, of whom 81.9% were diagnosed with PAH. For these 4626 patients, median duration of macitentan exposure observed was 14.5 (Q1 = 5.2, Q3 = 29.0) months; idiopathic PAH (54.8%) was the most common form of PAH; macitentan was initiated as monotherapy (37.9%), or as part of double (48.0%) or triple therapy (14.1%); discontinuation due to nonhepatic/hepatic adverse events occurred in 17.1%/0.3% of patients; 9.9% of patients experienced ≥1 hepatic adverse events; Kaplan–Meier estimates showed that at 1 year 59.9% (95% confidence interval: 58.3, 61.5) of patients were free from hospitalization and survival was 90.4% (89.3, 91.3). This analysis of real‐world data from the combined OPUS and OrPHeUS populations demonstrated that macitentan is well tolerated in a large, diverse population of PAH patients, with overall and hepatic safety profiles consistent with previous macitentan clinical trials.

Concomitant initiation of combination therapy with macitentan and tadalafil in pulmonary arterial hypertension (PAH) patients with comorbidities: real-world data from OPUS and OrPHeUS

Background

Guidelines for the management of pulmonary arterial hypertension (PAH) recommend early combination therapy of an endothelial receptor antagonist (ERA) and a phosphodiesterase type-5 inhibitor (PDE5i) [1]. There is, however, limited guidance about the management of PAH patients with comorbidities.

Purpose

To describe the demographics, clinical characteristics, safety, tolerability, and outcomes associated with initiation of the ERA macitentan and the PDE5i tadalafil in patients with comorbidities in the US OPsumit® USers (OPUS) and the OPsumit® Historical USers cohort (OrPHeUS) combined dataset.

Methods

This analysis reports data from the OPUS registry (Apr 2014–Jun 2020) and OrPHeUS medical chart review (Oct 2013–Mar 2017) on PAH patients initiating macitentan and tadalafil (M+T) combination therapy, in any order, as concomitant initiation (≤60 days apart, concomitant initiation group). The index date was defined as the start date of the second therapy (i.e., the start of combination therapy). Patients were further grouped by the number of comorbidities present prior to or at macitentan initiation: systemic hypertension, diabetes, renal insufficiency, BMI ≥30 kg/m2, other signs of right heart failure and atrial fibrillation. Results are presented descriptively alongside results for all PAH patients receiving M+T combination therapy (overall M+T group).

Results

Of the 1336 PAH patients that received M+T combination therapy, 431 (32%) were in the concomitant initiation group. In the concomitant initiation and overall M+T groups, respectively: 72% and 68% had ≥1 comorbidity, and the most common were systemic hypertension (47% and 47%), obesity (32% and 26%) and diabetes (23% and 22%). Patients were more likely to be older, male and have idiopathic/heritable PAH with increasing comorbidity burden (Table 1). Patients in the concomitant initiation group were more likely to be incident (median time from diagnosis: 1–2 months vs 9–24 months in the overall M+T group; Table 1). Most patients had ≥1 adverse event (AE); in both groups, patients with a high comorbidity burden (≥3) were more likely to have had an AE and to have discontinued treatment (Table 2). The incidence rate of first all-cause hospitalisation and mortality by comorbidity was comparable between the concomitant initiation and overall M+T groups.

Conclusions

In the real-world, concomitant initiation of M+T is used in PAH patients with comorbidities, usually shortly after diagnosis. Patient characteristics were similar for the concomitant initiation and overall M+T groups, with the exception of time from diagnosis. At index date, age, gender proportion, and PAH aetiology differed between the comorbidity groups. The safety profile of M+T combination therapy in the concomitant initiation group was consistent with that in the overall M+T group.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson

Longitudinal alterations in gamma-aminobutyric acid (GABAA) receptor availability over ∼ 1 year following traumatic brain injury

Longitudinal alterations of gamma-aminobutyric acid (GABA_A) receptor availability following traumatic brain injury have remained uncharacterized and may reflect changes in neuronal structure and function linked to cognitive recovery. We measured GABA_A receptor availability using the tracer [11C]flumazenil in nine adults with traumatic brain injury (3–6 months after injury, subacute scan) and in 20 non-brain-injured individuals. A subset of subjects with traumatic brain injury (n = 7) were scanned at a second chronic time-point, 7–13 months after their first scan; controls (n = 9) were scanned for a second time, 5–11 months after the first scan. After accounting for atrophy in subjects with traumatic brain injury, we find broad decreases in GABA_A receptor availability predominantly within the frontal lobes, striatum, and posterior-medial thalami; focal reductions were most pronounced in the right insula and anterior cingulate cortex (p < 0.05). Greater relative increase, compared to controls, in global GABA_A receptor availability appeared between subacute and chronic scans. At chronic scan (>1 year post-injury), we find increased pallidal receptor availability compared to controls. Conversely, receptor availability remained depressed across the frontal cortices. Longitudinal improvement in executive attention correlated with increases in receptor availability across bilateral fronto-parietal cortical regions and the anterior-lateral aspects of the thalami. The specific observations of persistent bi-frontal lobe reductions and bilateral pallidal elevation are consistent with the anterior forebrain mesocircuit hypothesis for recovery of consciousness following a wide range of brain injuries; our results provide novel correlative data in support of specific cellular mechanisms underlying persistent cognitive deficits. Collectively, these measurements support the use of [11C]flumazenil to track recovery of large-scale network function following brain injuries and measure response to therapeutics.

Trends in body mass index changes among Korean adolescents between 2005-2020, including the COVID-19 pandemic period: a national representative survey of one million adolescents

OBJECTIVE

The impact of the coronavirus disease 2019 (COVID-19) pandemic on weight gain in children and adolescents remains unknown. We aimed to identify an estimated 15-year trend in mean body mass index (BMI) changes and prevalence of obesity and overweight among Korean adolescents from 2005 to 2020, including the period of the COVID-19 pandemic.

PATIENTS AND METHODS

We analyzed data taken from a nationwide survey (Korea Youth Risk Behavior Survey), between 2005 and 2020. Representative samples of one million Korean adolescents aged 13-18 years (n=1,057,885) were examined. The 15-year trends in mean BMI and proportion of obesity or overweight, and the changes due to the COVID-19 pandemic were analyzed.

RESULTS

The data of 1,057,885 Korean adolescents were analyzed (mean age: 14.98 years; females, 48.4%). The estimated weighted mean BMI was 20.5 kg/m2 [95% confidence interval (CI), 20.4-20.5] from 2005 to 2008 and 21.5 kg/m2 (95% CI, 21.4-21.6) in 2020 (during the COVID-19 pandemic). Although the 15-year trend of mean BMI gradually increased, the change in mean BMI before and during the pandemic significantly lessened (βdiff, -0.027; 95% CI, -0.028 to -0.026). The 15-year (2005-2020) trend changes in the prevalence of obesity and overweight were similar (obesity prevalence from 2005-2008, 3.2%; 95% CI, 3.1-3.3 vs. obesity prevalence in 2020, 8.6%; 95% CI, 8.2-9.0; βdiff, -0.309; 95% CI, -0.330 to -0.288).

CONCLUSIONS

The 15-year trend of overall mean BMI and obesity and overweight prevalence demonstrated a significant increase; however, its slope decreased during the pandemic. These landmark results suggest the need for the development of precise strategies to prevent pediatric obesity and overweight during the COVID-19 pandemic.

Hypovascular Cellular Tumor in Primary Central Nervous System Lymphoma is Associated with Treatment Resistance: Tumor Habitat Analysis Using Physiologic MRI

BACKGROUND AND PURPOSE

The microenvironment of lymphomas is known to be highly variable and closely associated with treatment resistance and survival. We tried to develop a physiologic MR imaging-based spatial habitat analysis to identify regions associated with treatment resistance to facilitate the prediction of tumor response after initial chemotherapy in patients with primary central nervous system lymphoma.

MATERIALS AND METHODS

Eighty-one patients with pathologically confirmed primary central nervous system lymphoma were enrolled. Pretreatment physiologic MR imaging was performed, and K-means clustering was used to separate voxels into 3 spatial habitats according to ADC and CBV values. Associations of spatial habitats and clinical and conventional imaging predictors with time to progression were analyzed using Cox proportional hazards modeling. The performance of statistically significant predictors for time to progression was assessed using the concordance probability index.

RESULTS

The 3 spatial habitats of hypervascular cellular tumor, hypovascular cellular tumor, and hypovascular hypocellular tumor were identified. A large hypovascular cellular habitat was most significantly associated with short time to progression (hazard ratio, 2.83; P = . 017). The presence of an atypical finding (hazard ratio, 4.41; P = . 016), high performance score (hazard ratio, 5.82; P = . 04), and high serum lactate dehydrogenase level (hazard ratio, 1.01; P = .013) was significantly associated with time to progression. A predictive model constructed using the habitat score and other imaging parameters showed a concordance probability index for prediction of time to progression of 0.70 (95% CI, 0.54-0.87).

CONCLUSIONS

A hypovascular cellular tumor habitat is associated with treatment resistance in primary central nervous system lymphoma, and its assessment may refine prechemotherapy imaging-based response prediction for patients with primary central nervous system lymphoma.

Carotid Plaque Composition Assessed by CT Predicts Subsequent Cardiovascular Events among Subjects with Carotid Stenosis

BACKGROUND AND PURPOSE

Currently, the characteristics of carotid plaques are considered important factors for identifying subjects at high risk of stroke. This study aimed to test the hypothesis that carotid plaque composition assessed by CTA is associated with an increased risk of future major adverse cardiovascular events among asymptomatic subjects with moderate-to-severe carotid artery stenosis.

MATERIALS AND METHODS

This single-center, retrospective cohort study included 194 carotid plaques from 176 asymptomatic subjects with moderate-to-severe carotid artery stenosis. The association of CTA-determined plaque composition with the risk of subsequent adverse cardiovascular events was analyzed.

RESULTS

During a median follow-up of 41 months, the adverse cardiovascular event incidence among 194 carotid plaques was 19.6%. There were significant differences in plaque Hounsfield units (P < .001) and spotty calcium presence (P < .001) between carotid plaques from subjects with and without subsequent adverse cardiovascular events. Multivariable analysis revealed carotid plaque Hounsfield unit density (P < .001) and spotty calcium (P < .001) as independent predictors of subsequent adverse cardiovascular events. In association with moderate carotid artery stenosis, the plaque Hounsfield unit values were significantly lower among carotid plaques from subjects who experienced subsequent adverse cardiovascular events (P = .002), strokes (P = .01), and cardiovascular deaths (P = .04); the presence of spotty calcium was significantly associated with the occurrence of adverse cardiovascular events (P = .001), acute coronary syndrome (P = .01), and cardiovascular death (P = .04).

CONCLUSIONS

Carotid plaque Hounsfield unit density and spotty calcium were independent predictors of a greater risk of adverse cardiovascular event occurrence.

A study on accumulator analysis for the valve performance evaluation system of nuclear power plants

To evaluate the valves used in the nuclear power plants are working properly under the required conditions, the performance and capacity test should be performed. In the test system, the accumulator was employed to control the large amount of high pressure and high temperature steam generated in the boiler precisely. In the accumulating process, the steam is often condensed. In order to prevent condensation, it is needed to install heaters and preheat the accumulator. However, if the size of the accumulator becomes large, the installation of the heater may not be easy. Therefore, when the test is conducted, the system was preheated by the latent heat generated from the phase change. Insufficient thermal insulation may cause temperature differences and it can cause mechanical problems in the accumulator structure. If insulation is sufficient, the temperature difference is indicated by the height. As the cooled condensate moves downwards, the condensate is discharged by the drain valve control and the temperature difference of the structure can be disappeared. The results of this paper can be applied to the conceptualization of equipment that uses latent heat and for the design of high-precision steam experimental devices or the design of high-capacity steam utilization systems.

Association of low skeletal muscle mass with the presence of advanced colorectal neoplasm: integrative analysis using three skeletal muscle mass indices

AIM

This study aimed to evaluate an association between colorectal neoplasm (CRN) and skeletal muscle mass using three widely accepted skeletal muscle mass indices (SMIs) in a large population at average risk.

METHOD

We performed a cross-sectional study using a screening colonoscopy database of 33 958 asymptomatic subjects aged 40-75 years. Appendicular skeletal muscle mass (ASM) was measured using a bioelectrical impedance analyser. ASM adjusted for height squared (ASM/ht² ), weight (ASM/wt) and body mass index (ASM/BMI) were used as indices for muscle mass. Logistic regression models were used to evaluate the association between SMIs and CRN.

RESULTS

In a multivariable-adjusted model, the risk of an advanced CRN increased linearly with decreasing quartiles for all three SMIs. The adjusted odds ratios (ORs) for advanced CRN in quartiles 1, 2 and 3 of ASM/wt compared with that in quartile 4 were 1.279, 1.196 and 1.179, respectively (P_trend  = 0.017); for ASM/BMI, ORs were 1.307, 1.144 and 1.091, respectively (P_trend  = 0.002); and for ASM/ht² , ORs were 1.342, 1.169 and 1.062, respectively (P_trend  = 0.002). The risk of distally located advanced CRN was higher in quartile 1 than in quartile 4 for all three SMIs (ASM/wt, OR = 1.356; ASM/BMI, OR = 1.383; ASM/ht² , OR = 1.430).

CONCLUSION

Our study demonstrated that low skeletal muscle mass was consistently associated with the presence of advanced CRN in a population at average risk regardless of the operational definition of the SMI, and it was particularly associated with distal advanced CRN.

Geospatial Distribution and Predictors of Mortality in Hospitalized Patients With COVID-19: A Cohort Study

BACKGROUND

The global coronavirus disease 2019 (COVID-19) pandemic offers the opportunity to assess how hospitals manage the care of hospitalized patients with varying demographics and clinical presentations. The goal of this study was to demonstrate the impact of densely populated residential areas on hospitalization and to identify predictors of length of stay and mortality in hospitalized patients with COVID-19 in one of the hardest hit counties internationally.

METHODS

This was a single-center cohort study of 1325 sequentially hospitalized patients with COVID-19 in New York between March 2, 2020, to May 11, 2020. Geospatial distribution of study patients' residences relative to population density in the region were mapped, and data analysis included hospital length of stay, need and duration of invasive mechanical ventilation (IMV), and mortality. Logistic regression models were constructed to predict discharge dispositions in the remaining active study patients.

RESULTS

The median age of the study cohort (interquartile range [IQR]) was 62 (49-75) years, and more than half were male (57%) with history of hypertension (60%), obesity (41%), and diabetes (42%). Geographic residence of the study patients was disproportionately associated with areas of higher population density (r s = 0.235; P = .004), with noted "hot spots" in the region. Study patients were predominantly hypertensive (MAP > 90 mmHg; 670, 51%) on presentation with lymphopenia (590, 55%), hyponatremia (411, 31%), and kidney dysfunction (estimated glomerular filtration rate < 60 mL/min/1.73 m2; 381, 29%). Of the patients with a disposition (1188/1325), 15% (182/1188) required IMV and 21% (250/1188) developed acute kidney injury. In patients on IMV, the median (IQR) hospital length of stay in survivors (22 [16.5-29.5] days) was significantly longer than that of nonsurvivors (15 [10-23.75] days), but this was not due to prolonged time on the ventilator. The overall mortality in all hospitalized patients was 15%, and in patients receiving IMV it was 48%, which is predicted to minimally rise from 48% to 49% based on logistic regression models constructed to project disposition in the remaining patients on ventilators. Acute kidney injury during hospitalization (odds ratioE, 3.23) was the strongest predictor of mortality in patients requiring IMV.

CONCLUSIONS

This is the first study to collectively utilize the demographics, clinical characteristics, and hospital course of COVID-19 patients to identify predictors of poor outcomes that can be used for resource allocation in future waves of the pandemic.

SAT0385 CAN MISCLASSIFICATION BETWEEN SPONDYLOARTHRITIS (SPA) AND RHEUMATOID ARTHRITIS (RA) OCCUR? SPA-RELATED CLINICAL MANIFESTATIONS AMONG RA AND SPA PATIENTS - A SYSTEMATIC LITERATURE REVIEW

Background:

Delayed diagnosis is associated with worse outcomes and poor treatment responses in patients with SpA, including psoriatic arthritis (PsA) and axial spondyloarthritis.1Misclassification may be associated with this delay, as SpA and RA, especially seronegative RA, may present with similar manifestations such as joint pain, swelling, fatigue, and disability. Key features that typically distinguish SpA from RA include spine pain, dactylitis, enthesitis, psoriasis, and nail psoriasis.2Increased physician awareness of the potential overlap and distinctions between SpA and RA manifestations is needed for the early diagnosis and appropriate treatment for SpA.

Objectives:

To identify and summarise the published literature on the prevalence of SpA-related clinical manifestations among patients with RA and SpA.

Methods:

Publications were retrieved from Embase®, Cochrane, MEDLINE®, and MEDLINE® In-Process databases. Studies were included if they were non-interventional, recruited patients with RA and SpA, or patients with seronegative/seropositive RA, and reported the following manifestations: enthesitis, dactylitis, axial symptoms, psoriasis, or nail psoriasis. Two reviewers assessed each citation against predefined eligibility criteria, with discrepancies reconciled by a third independent reviewer.

Results:

Of the 4479 publications retrieved, 18 studies were included (Figure 1). All studies compared SpA populations to patients with RA. Of the 18 studies, 11 studies reported patients with only PsA, 2 studies reported patients with only ankylosing spondylitis (AS), and 5 studies reported mixed SpA populations. Three studies each reported data pertaining to seropositive/seronegative RA and early RA, defined as symptom onset <1 year. The majority (N=12) of studies used ultrasound imaging to identify manifestations of interest. Enthesitis (N=17) was the most frequently evaluated manifestation while axial symptoms (N=2) was least evaluated. Of the studies reporting enthesitis, the majority (N=14) reported a higher prevalence of enthesitis in the SpA cohort compared to the RA cohort. The remaining studies (N=3) reported no significant difference in enthesitis between the SpA and RA cohorts. Notably, these 3 studies comprised of the 2 studies evaluating only AS patients, and all 3 studies evaluated late RA patients. In contrast, the 3 studies that reported early RA and PsA patients found a significantly higher prevalence of enthesitis in early PsA vs. early RA cohort. Two of the 3 studies reporting RA serostatus found a higher prevalence of enthesitis, psoriasis, and/or nail psoriasis in the SpA population compared to seronegative and seropositive RA cohorts. All studies reporting axial symptoms, dactylitis, psoriasis, and nail psoriasis found a higher prevalence of the corresponding manifestation in the SpA vs. RA cohort.

Conclusion:

While this review found a higher prevalence of key SpA-related clinical manifestations in SpA vs. RA, overlap was present suggesting that misclassification could occur. Differences in the prevalence of manifestations were also seen in the early vs. late RA populations as well as by RA serostatus. This suggests that an earlier and comprehensive evaluation, including advanced imaging of peripheral manifestations such as enthesitis, dactylitis, axial symptoms, and skin signs such as psoriasis and nail disease, among RA and SpA patients may reduce misclassification and inappropriate treatment. Further research is needed to confirm these findings.

References:

[1]Seo et al. Clin Rheumatol. 2015;34:1397-1405.

[2]Merola et al. RMD. 2018;4:e000656.

Acknowledgments:

This study was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, NJ.

Disclosure of Interests:

Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Mohit Kumar Bhutani Employee of: Novartis Healthcare Pvt Ltd, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation, Nina Kim Employee of: Postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis Pharmaceuticals Corporation

SAT0429 SECUKINUMAB IMPROVES CLINICAL AND PATIENT-REPORTED OUTCOMES AT 6 MONTHS AMONG PATIENTS WITH PSORIATIC ARTHRITIS IN THE US-BASED CORRONA PSORIATIC ARTHRITIS/SPONDYLOARTHRITIS (PsA/SpA) REGISTRY

Background:

Secukinumab, an interleukin-17 antagonist approved for the treatment of PsA, improves all PsA manifestations in the GRAPPA-OMERACT core domain set.1Few US-based studies have evaluated the real-world effectiveness of secukinumab in patients with PsA.

Objectives:

To examine clinical and patient-reported outcomes (PROs) in patients with PsA enrolled in the Corrona PsA/SpA registry initiating secukinumab with ≥ 1 follow-up visit.

Methods:

Included were adult patients with PsA in the Corrona registry who initiated secukinumab after April 1, 2017 and remained on secukinumab at their 6-month (window, 5-8 months) follow-up visit. The primary outcome was achievement of minimal disease activity (MDA) at 6 months among patients not in MDA at secukinumab initiation. MDA was defined as meeting 5 of the 7 following criteria: tender joint count (TJC) ≤ 1, swollen joint count (SJC) ≤ 1, psoriasis affected body surface area (BSA) < 3%, patient assessment of pain on visual analog scale (VAS) ≤ 15, patient global assessment VAS ≤ 20, HAQ-DI ≤ 0.5, and tender entheseal points ≤ 1 using the Leeds Enthesitis Index (LEI). Secondary outcomes included the proportion of patients who achieved resolution (0 sites) of TJC, SJC, enthesitis (using the LEI), and dactylitis among those with ≥ 1 site at initiation and improvement from baseline in clinical outcomes (BSA, nail psoriasis, physician global assessment, TJC, SJC, and DAPSA) and PROs (patient-reported pain, patient global assessment, HAQ-DI, and Work Productivity and Activity Impairment questionnaire) at 6 months. Outcomes were evaluated in the overall population and in potentially recalcitrant patients with failure of or intolerance to ≥ 3 previous biologics to examine if the later line biologic could be adequately effective.

Results:

A total of 100 patients with PsA who initiated and maintained secukinumab after 6 months were included. The mean (SD) age was 51.6 (11.6) years, 54.3% were male, and 96.8% were white. The mean (SD) symptom and disease duration were 10.8 (9.7) and 7.0 (7.0) years, respectively. Thirty patients (30.0%) initiated secukinumab 150 mg and 70 (70.0%) initiated secukinumab 300 mg. Most (83.0%) were biologic experienced; 17 patients initiated secukinumab as a 1st biologic, 34 as 2nd, 26 as 3rd, and 23 as ≥ 4th. At initiation, 75/90 patients (83.3%) were not in MDA; 26/71 (36.6%) of those with follow-up data available achieved MDA at 6 months (Figure 1). In the overall population, 28 patients (41.2%) with TJC ≥ 1, 24 (44.4%) with SJC ≥ 1, 17 (60.7%) with enthesitis, and 9 (75.0%) with dactylitis at initiation achieved resolution at 6 months (Table 1). Improvement was observed at 6 months in clinical outcomes and PROs in the overall population (Figures 1 and 2) and in patients who initiated secukinumab as a ≥ 4th-line biologic.

Table 1.

Resolution of Peripheral Arthritis, Enthesitis, and Dactylitis at 6 Months Among Patients With ≥ 1 Site at Initiation

Secondary OutcomesInitiation,Mean (SD) [n]6-Month Follow-Up,Resolution (Count = 0), n (%)TJC (1-68)9.0 (9.7) [68]28 (41.2)SJC (1-66)4.7 (4.2) [54]24 (44.4)Enthesitis (1-6)1.9 (1.1) [28]17 (60.7)Dactylitis (1-20)2.1 (1.3) [12]9 (75.0)

Conclusion:

In the Corrona registry, most secukinumab initiators with PsA were biologic experienced and were not in MDA at time of initiation. Consistent with clinical trials, real-world patients treated with secukinumab achieved MDA as well as improvement in clinical manifestations, PROs, and work productivity.

References:

[1]Orbai AM, et al.J Rheumatol.2019 Oct 15. [Epub ahead of print].

Disclosure of Interests:

Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Taylor Blachley Employee of: Corrona, LLC, Meghan Glynn Shareholder of: Corrona, LLC – shareholder, Grant/research support from: Pfizer – grant/research support, Employee of: Corrona, LLC – employment, Blessing Dube Employee of: Corrona, LLC, Robert McLean Employee of: Corrona, LLC, Nina Kim Employee of: Postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis Pharmaceuticals Corporation, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, Alexis Ogdie Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis, Pfizer

0455 Role of Interaction Between Anterior Insula Response to Sleep-Related Pictures and Stress Levels on Sleep Disturbance

Introduction

Literature suggests that stress may play an important role in sleep disturbance. Individuals with higher stress levels often showed hyperarousal to stressful events, possibly leading to sleep disturbance. Hyperarousal is also one of features of stress-related sleep disturbance. Here, we examined the extent to which stress levels interact with neural activity in response to sleep-related information to predict sleep disturbance.

Methods

Forty eight healthy adults (26 females, age = 35.7 ± 10.5) without sleep disorders based on nocturnal polysomnography participated in this study. They were viewing sleep-related pictures (e.g., bedroom and sunset) and non-sleep related, neutral pictures (e.g., kitchen and landscape) during fMRI scanning. They also completed questionnaires assessing stress levels and sleep disturbance using Life Experience Survey (LES) and Pittsburgh Sleep Quality Index (PSQI), respectively. Activity in response to sleep-related pictures compared to neutral pictures was extracted from our region-of-interest (ROI), the anterior insula, and entered into our moderation models. The SPSS macro PROCESS (Hayes, 2013) was used to conduct moderation analyses. Given a significant correlation between age and PSQI scores, age was included as a covariate.

Results

Our moderation analyses showed that interactions between stress levels and anterior insula response to sleep-related pictures significantly predicted sleep disturbance. Simple slope analyses showed that at higher anterior insula response, higher stress levels were associated with greater sleep disturbance, but at lower anterior insula response, stress was not significantly associated with sleep disturbance. These results indicate that individuals with high levels of stress were more likely to experience sleep disturbance if they showed greater anterior insula response to sleep-related pictures (i.e., hyperarousal in response to sleep-related information).

Conclusion

The current findings suggest that interactions between stress levels and neural substrates of hyperarousal, particularly the anterior insula, may play a critical role in sleep disturbance.

Support

Brain Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (Study No.: 2016M3C7A1904338 and NRF-2018R1D1A1B07049704).

0064 Heightened Neural Responses to Negative Words in Shift Workers Using the Stroop Task

Introduction

Shift work is known to have a negative impact on a wide range of health problems such as sleep disturbance, cognitive impairment, and emotional disorders (e.g., anxiety and depression). It is important to understand underlying mechanisms for negative impact of shift work on health problems. This study aimed to investigate psychological and neural mechanisms associated with shift work.

Methods

Thirty six shift workers (28 females, age = 29.9 ± 7.4) and 35 non-shift workers (20 females, age = 30.5 ± 5.5) participated in this study. They were performing the word Stroop task during fMRI scanning. This task included sleep-related words and negative words to investigate neural substrates associated with sleep-related information and emotional information processing. Neutral words were included as control stimuli. The participants also completed questionnaires assessing sleep-related problems such as Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale, and emotion-related problems such as Beck Depression Inventory and Beck Anxiety Inventory. Two-sample t-tests were conducted to find group differences in self-report measures and neural response to sleep-related words and negative words compared to neutral words.

Results

Relative to non-shift workers, shift workers showed greater sleep disturbance (i.e., higher PSQI), but they did not show any evidence of emotion-related problems. Shift workers also demonstrated greater neural response to negative words (vs. neutral words) in several prefrontal regions (e.g., dorsal anterior cingulate cortex and dorsolateral prefrontal cortex), anterior insula and caudate compared to non-shift workers. However, shift workers did not show significantly different neural response to sleep-related words (vs. neutral words) compared to non-shift workers.

Conclusion

The result from this study provides supporting evidence that shift work is associated with subjective sleep disturbance. Shift workers’ heightened neural response to negative information may reflect their increased sensitivity to negative information, that may contribute to sleep disturbance.

Support

Brain Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (Study No.: 2016M3C7A1904338 and NRF-2018R1D1A1B07049704).

0073 Left Anterior Cingulate Hyperarousal During Sleep Anxiety-Inducing Emotional Tasks Performance in Patients with Insomnia Disorder

Introduction

Patients with insomnia frequently experience sleep/insomnia-related anxiety; this anxiety has been associated with hyperarousal. We investigated the underlying brain function changes in patients with insomnia during emotional task performance that induced sleep/insomnia-related anxiety.

Methods

Functional magnetic resonance imaging (fMRI) was performed during emotional task performance in healthy individuals and patients with insomnia who met the diagnostic criteria of insomnia disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and had chronic insomnia for more than 6 months. The participants underwent fMRI scanning during three types of emotional task performance—insomnia-anxiety task, reading sentences that cause insomnia-related anxiety; general-anxiety task, reading sentences that cause anxiety for everyone; and neutral task, reading neutral sentences that do not cause emotional anxiety. The images obtained from fMRI and blood oxygen level-dependent (BOLD) signal changes were compared between patients with insomnia and healthy controls. Interim analysis was performed with the data of 13 patients with insomnia and 9 controls.

Results

The brain activity in the left anterior cingulate was higher during insomnia-anxiety task performance than that during general-anxiety task performance in the insomnia group (voxel-wise uncorrected p &lt; 0.05; cluster size, 100). In the insomnia group, the brain activity during insomnia-anxiety task performance was not lower in any brain area than that during general-anxiety task performance.

Conclusion

We show that patients with chronic insomnia experience sleep anxiety related with hyperarousal in the left anterior cingulate area. Additional subject recruitment and re-analysis are needed to confirm the findings of this interim analysis.

Support

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03032431).