AO Spine Adult Spinal Deformity Patient Profile: A Paradigm Shift in Comprehensive Patient Evaluation in Order to Optimize Treatment and Improve Patient Care

Study Design: Modified Delphi study. Objective: Adult spinal deformity (ASD) is an increasingly recognized condition, comprising a spectrum of pathologies considerably impacting patients' health and functional status. Patients present with a combination of pain, disability, comorbidities and radiological deformity. The study aims to propose a systematic approach of gathering information on the factors that drive decision-making by developing a patient profile. Methods: The present study comprises of 3 parts. Part 1: Development of prototype of patient profile: The data from the Core Outcome Study on SCOlisis (COSSCO) by Scoliosis Research Society (SRS) was categorized into a conceptual framework. Part 2: Modified Delphi study: Items reaching >70\% agreement were included in a 4 round iterative process with 51 panellists across the globe. Part 3: Pilot testing-feasibility: Content validity and usability were evaluated quantitatively. Results: The profile consisted of 4 domains. 1. General health with demographics and comorbidities, 2.Spine-specific health with spine related health and neurological status, 3. Imaging with radiographic and MRI parameters and 4. Deformity type. Each domain consisted of 1 or 2 components with various factors and their measuring instruments. Profile was found to have an excellent content validity (1-CVIr 0.78-1.00Ave-CVI 0.92) appropriateness, relevance and usefulness. Conclusions: The present study, is first to provide a universally applicable multimodal ASD patient profile to methodically describe patients. Physicians are encouraged to assess ASD patients holistically using this profile and not just based on radiographic findings

Clinical Outcome and Characteristics of Turkish Breast Cancer Patients who had SARS-Cov-2 Infection

OBJECTIVE COVID-19 pandemic has placed an unprecedented burden on health-care system. Patients with cancer are reported to have a higher risk of infection and a more complicated COVID-19 course. Breast cancer (BC) is the most common cancer in women in Turkey. We report clinical outcomes and characteristics of patients with COVID-19 who were on treatment for BC at our center. METHODS We reviewed medical records of BC patients who had COVID-19 between July 2020 and 2021 at our center. We recorded pathological, clinical, treatment characteristics, and the clinical outcome of COVID-19 infection. RESULTS A total 82 BC patients had COVID-19 between July 2020 and 2021. All patients were female, with a median age of 49 (43-64 years). 85\% of all patients had early and 14.6\% of them had advanced stage BC. COVID-19 had a mild clinical course in 73\%, hospitalization was required in 27\% of patients. Twenty-five patients who required hospitalization were discharged and three patients died due to COVID-19. All of the patients who died from COVID-19 had metastatic BC (p=0.002). Metastatic disease (p=0.002) and chemotherapy within 7 days of COVID-19 diagnosis (p=0.024) have been associated with increased mortality. CONCLUSION Majority of BC patients with COVID-19 have a mild course, patients with risk factors that increase mortality should be followed more carefully

Predictive value of preoperative MRI using the \#ENZIAN classification score in patients with deep infiltrating endometriosis

Purpose The aim of this study is to investigate the correlation between the magnetic resonance imaging (MRI) and intraoperative findings of deep infiltrating endometriosis using the \#ENZIAN score. Methods This retrospective study included 64 patients who underwent surgery for deep infiltrating endometriosis between January 2017 and August 2020. Preoperative abdominopelvic MRI assessment was evaluated and scored using the \#ENZIAN classification. Operative scores were considered the gold standard, and the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of MRI for each category were calculated. Results MRI has higher sensitivity and specificity in showing the lesions of the compartments O (ovarian lesions), A (rectovaginal septum and posterior vaginal fornix), and B (uterosacral ligaments and parametrium) (100-100\%, 100-100\%, and 97-100\%, respectively, p < 0.001) compared to the other compartments. The lowest sensitivity, specificity, accuracy, and PPV of the MRI was found in compartment P (14\%, 76\%, 70\%, and 7\%, respectively). Conclusion We demonstrated that the \#ENZIAN classification in MRI reports has significant sensitivity and specificity in compartments A, B (uterosacral ligaments and parametrium), and O. Furthermore, the determination of peritoneal lesions via MRI is inadequate.1JAN215-22030

Identifying and elucidating the roles of Y198N and Y204F mutations in the PAH enzyme through molecular dynamic simulations

Phenylketonuria is an autosomal recessive disorder caused by mutations in the phenylalanine hydroxylase gene. In phenylketonuria causes various symptoms including severe mental retardation. PAH gene of a classical Phenylketonuria patient was sequenced, and two novel heterozygous mutations, p.Y198N and p.Y204F, were found. This study aimed to reveal the impacts of these variants on the structural stability of the PAH enzyme. In-silico analyses using prediction tools and molecular dynamics simulations were performed. Mutations were introduced to the wild type catalytic monomer and full length tetramer crystal structures. Variant pathogenicity analyses predicted p.Y198N to be damaging, and p.Y204F to be benign by some prediction tools and damaging by others. Simulations suggested p.Y198N mutation cause significant fluctuations in the spatial organization of two catalytic residues in the temperature accelerated MD simulations with the monomer and increased root-mean-square deviations in the tetramer structure. p.Y204F causes noticeable changes in the spatial positioning of T278 suggesting a possible segregation from the catalytic site in temperature accelerated MD simulations with the monomer. This mutation also leads to increased root-mean-square fluctuations in the regulatory domain which may lead to conformational change resulting in inhibition of dimerization and enzyme activation. Our study reports two novel mutations in the PAH gene and gives insight to their effects on the PAH activity. MD simulations did not yield conclusive results that explains the phenotype but gave plausible insight to possible effects which should be investigated further with in-silico and in-vitro studies to assess the roles of these mutations in etiology of PKU. Communicated by Ramaswamy H. Sarm

Sequential percutaneous tricuspid and pulmonary valve implantation in a young child operated previously for Ebstein Anomaly

We report a successful percutaneous tricuspid valve implantation followed by a percutaneous pulmonary valve implantation in a young child with Ebstein's anomaly of tricuspid valve and pulmonary stenosis who was previously treated surgically at 1 year of age with tricuspid ring annuloplasty and a transannular outflow patch. This article shows the feasibility of sequential implantation of two valves in young patients with severe tricuspid and pulmonary valve insufficiency

finalizing the protocol MF07-01 randomized clinical trial

4SFEB8

The immediate effect of deliberate practice and real-time feedback on high-quality CPR training in intern doctors, acute care providers, and lay rescuers

The quality of cardiopulmonary resuscitation (CPR) is the main determinant of survival in cardiac arrest, so high-quality CPR (HQ-CPR) from bystanders is essential. The best instructional model for HQ-CPR performed by bystanders remains under investigation, and an instructional model's effect on various learner types is unknown. This study examined the immediate effect of a brief, blended instructional design that combines deliberate practice (DP) with real-time feedback (RTF) on the booster training of intern doctors (IDs) and acute care providers (ACPs) as well as on the skills acquisition training of lay rescuers (LRs). This cohort crossover study was conducted in a university-affiliated hospital in January 2020. Just-in-time training on HQ-CPR that featured a popular song was provided to IDs (n = 24), ACPs (n = 29), LRs (n = 25)groups performed one-minute cardiac compressions twice, without RTF and with verbal coaching, followed by debriefing, and then with only RTF. The impact of RTF on depth, rate, compression quality (CQ), and recoil was assessed. RTF significantly improved depth, rate, CQ, and recoil (p < 0.001). Among the LRs, the depth was 0.2 millimeters below the lower cutoff. Without RTF, the previously trained IDs and ACPs tended to perform inadequately faster and deeper compressions, while the untrained LRs performed slower, shallow compressions. DP combined with RTF yielded a significant immediate effect on the HQ-CPR training outcomes of all learner types.2MAR48-551

Skin Biopsy Results of Geriatric Patients Over a 5-year Period and the Frequency of Skin Diseases Before and After COVID-19 Pandemic

Objective: The number of older adults has increased throughout the world. Aging affects all the organs and creates psychological, physiologic and anatomic changes. One of the most important organs of the human body is the skin, which shows the effects of aging the most. This study aims to determine whether age, gender, and season of biopsy play a significant role in skin biopsy results. Additionally, the study investigates whether the frequency of skin diseases differs before and after the coronavirus disease-2019 (COVID-19) pandemic. Methods: We conducted a retrospective study on the histopathology results of patients over 65 years old between June 2016 and September 2021. The histopathology results were obtained from the Acibadem Pathology Department. Results: Of the 677 patients, 310 (45.8\%) were male and 367 (54.2\%) were female. The most common disease in all patients were benign cutaneous neoplasms (23\%), followed by eczematous disease (18.5\%) and epithelial cutaneous cancers (16.8\%). We divided the results into 12 groups: group 1: Urticaria, erythema and purpuras, group 2: Papulosquamous and eczematous diseases, group 3: Infectious diseases, group 4: Rheumatologic diseases and alopecia, group 5: Benign cutaneous neoplasms, group 6: Precancerous lesions, group 7: Basal cell carcinoma, squamous cell carcinoma, group 8: Cutaneous metastasis and other skin cancers, group 9: Pigmentation disorders, group 10: Pschycology related dermatological disorders, group 11: Granulomatous dermatitis, group 12: Bullous dermatitis. Before the COVID-19 pandemic, the most prevalent results were group 2 (21.3\%), followed by group 5 (20.4\%) and group 7 (16.7\%) whereas, after the COVID-19 pandemic, the most frequent results were group 5 (28.4\%) followed by group 7 (17.1\%), and group 6 (14.9\%). In terms of seasons, the most common diseases were group 5 (24.1\%) in winter, group 2 (21.6\%) in spring, group 5 (30.0\%) in summer, and group 2 (18.9\%) in autumn. Before the COVID-19 pandemic, the most common result was group 2 (21.3\%), followed by group 5 (20.4\%) and group 7 (16.7\%), and during the COVID-19 pandemic, the most common result was group 5 (28.4\%), followed by group 7 (17.1\%), group 6 (14.9\%). Conclusion: Many skin diseases affect the geriatric population. Geriatric patients face challenges such as multiple drug use, comorbidities, mobility problems and cognitive disorders. In our study, the most common diseases in all patients were benign cutaneous neoplasms (23\%), followed by eczematous diseases (18.5\%), and epithelial cutaneous cancers (16.8\%). Knowing about the frequency of skin diseases is critical for the early detection of precancerous and cancerous lesions.2JUN189-1941

Hypoxia Aggravates Inhibition of Alveolar Epithelial Na-Transport by Lipopolysaccharide-Stimulation of Alveolar Macrophages

Inflammation and hypoxia impair alveolar barrier tightness, inhibit Na- and fluid reabsorption, and cause edema. We tested whether stimulated alveolar macrophages affect alveolar Na-transport and whether hypoxia aggravates the effects of inflammation, and tested for involved signaling pathways. Primary rat alveolar type II cells (rA2) were co-cultured with rat alveolar macrophages (NR8383) or treated with NR8383-conditioned media after stimulation with lipopolysaccharide (LPS1 mu g/mL) and exposed to normoxia and hypoxia (1.5\% O-2). LPS caused a fast, transient increase in TNF alpha and IL-6 mRNA in macrophages and a sustained increase in inducible nitric oxide synthase (NOS2) mRNA in macrophages and in rA2 cells resulting in elevated nitrite levels and secretion of TNF-alpha and IL-6 into culture media. In normoxia, 24 h of LPS treated NR8383 decreased the transepithelial electrical resistance (TEER) of co-cultures, of amiloride-sensitive short circuit current (ISC Delta amil)whereas Na/K-ATPase activity was not affected. Inhibition was also seen with conditioned media from LPS-stimulated NR8383 on rA2, but was less pronounced after dialysis to remove small molecules and nitrite. The effect of LPS-stimulated macrophages on TEER and Na-transport was fully prevented by the iNOS-inhibitor L-NMMA applied to co-cultures and to rA2 mono-cultures. Hypoxia in combination with LPS-stimulated NR8383 totally abolished TEER and ISC Delta amil. These results indicate that the LPS-stimulation of alveolar macrophages impairs alveolar epithelial Na-transport by NO-dependent mechanisms, where part of the NO is produced by rA2 induced by signals from LPS stimulated alveolar macrophages.15AUG2