Agreeing a set of biopsychosocial variables for collection across the UK Eating Disorders Clinical Research Network (EDCRN):A consensus study using adapted nominal group technique

Background: Eating disorders are serious psychiatric disorders associated with high levels of co-occurring physical and mental health conditions and poor treatment outcomes. The collection of standardised, routinely collected data within clinical services holds promise to improve patient care. Objective: To agree on a set of biopsychosocial variables for routine data collection within eating disorder services in the UK.Methods: Two online workshops were conducted using an adapted nominal group technique to agree on priorities for data collection in adult and child/adolescent eating disorder services. Workshop participants (n=43) consisted of people with lived experience, carers, clinicians and researchers. Two researchers independently conducted a reflexive thematic analysis of the workshop transcripts to identify qualitative priorities for data collection. Descriptive statistics were used to analyse the results of online voting. Findings: Thematic analysis identified four superordinate themes for data collection in eating disorder services: (1) a mutually valued and beneficial collaboration; (2) a holistic approach; (3) a balance between standardisation and individualisation; (4) doing no harm. Quantitative analysis of voting identified priorities across a range of domains, leading to a proposed biopsychosocial dataset.Conclusions: This project agreed on a set of biopsychosocial variables for routine data collection in the UK Eating Disorders Clinical Research Network. Further research should evaluate the implementation success of these variables.Clinical implications: Patients, caregivers, and clinicians support routine data collection in eating disorders services so long as the measures used are considered meaningful, not overly burdensome, non-stigmatising, and collected in collaboration between patients and treatment providers. <br/

Flow-diverting Stent-assisted Coil Embolization of a Ruptured Internal Carotid Artery Blister Aneurysm with the Pipeline Flex Embolization Device

Internal carotid artery (ICA) blister aneurysms are rare and challenging to successfully treat, using contemporary surgical or endovascular approaches, without partial or complete compromise of the parent vessel. We describe the use of a resheathable flow diverter, the Pipeline Flex Embolization Device (PFED) to perform stent-assisted coiling of a ruptured supraclinoid ICA blister aneurysm in a 56-year-old female who presented with a high-grade subarachnoid hemorrhage (SAH). The first PFED was deployed across the aneurysm neck to jail a microcatheter within the aneurysm dome, and then, two small coils were delivered into the aneurysm. After removing the coiling microcatheter, the second PFED was telescoped into the first PFED. There were no postprocedural complications, and follow-up magnetic resonance angiography 15 months after embolization showed complete aneurysm obliteration. Flow-diverting stent-assisted coiling should be considered as a reconstructive, vessel-preserving, endovascular treatment option for appropriately selected patients with ruptured ICA blister aneurysms. However, future studies are necessary to assess the periprocedural safety in the setting of acute SAH

Abstract 4553: Pre-Operative Brain Injury in Newborn Infants with Transposition of the Great Arteries Occurs at Similar Rates to other Complex Congenital Heart Disease, and is not Related to Balloon Atrial Septostomy

Introduction: Brain injury (BI) in the form of white matter injury (WMI) or ischaemic stroke, seen on magnetic resonance imaging (MRI), is common in neonates with congenital heart disease (CHD). It has previously been suggested that balloon atrial septostomy (BAS) may be an independent risk factor for pre-operative BI in neonates with transposition of the great arteries (TGA). Hypothesis : We hypothesised that: 1. The incidence of BI is similar in neonates with TGA and other severe CHD 2. The risk of pre-operative BI is not increased by BAS Methods: Neonates with TGA, hypoplastic left heart syndrome (HLHS) or pulmonary atresia (PA) were enrolled in a prospective study of BI related to CHD. Pre-operative brain MRI was performed in all patients. In those with TGA who underwent BAS, MRI occurred after septostomy. T1, T2 and diffusion-weighted images were obtained in axial and coronal planes. Scans were reviewed by blinded assessors, and were classified according to WMI (punctate lesions) or ischaemic stroke. Fisher’s Exact Test was used to compare rates of WMI and stroke in each patient group. Results: Sixty-six neonates (mean weight 3.4±0.5kg) were studied, of whom 44 had TGA, 13 had HLHS and 9 had PA. The median age at MRI was 7 days (range 1–31). Thirty-five of the neonates with TGA underwent BAS a median of 1 day (1–21) followed by MRI 7 days (2–12) later. BI was present in 17 (26%) patients. The table shows the incidence of BI in the sub-groups. Two neonates with a stroke also had WMI. Table showing MRI abnormalities in patient sub-groups. Neonates with TGA were not at increased risk of pre-operative BI compared with those with HLHS or PA (p=1.0). BAS did not increase the risk of pre-operative BI in neonates with TGA (p=1.0). Conclusions: Pre-operative BI occurs at a similar rate in neonates with TGA and other severe CHD. The risk of pre-operative BI in neonates with TGA is not increased by BAS. </jats:p

Subdural Hemorrhage and Hypoxia in Infants With Congenital Heart Disease

BACKGROUND AND OBJECTIVES: It has been suggested that there is a causal relationship between hypoxia and subdural hemorrhage (SDH) in infancy. The purpose of this study was to review the incidence of SDH in infants with congenital heart disease and explore the relationship between SDH and hypoxia. METHODS: Review of data collected for a prospective longitudinal cohort study of infants undergoing surgery for congenital heart disease in New Zealand and Australia. Infants underwent serial MRI scans of the brain in the first 3 months of life. All oxygen saturation recordings and MRI results were extracted and infants assigned to categories by degree of hypoxia. The data were then examined for any statistically significant relationship between hypoxia and SDH. RESULTS: One hundred fifty-two infants underwent MRI scans, and 66 (43%) had 145 loci of SDH. New SDH was seen in 12 infants after cardiac surgery. Of the loci of SDH, 63 (43%) were supratentorial, and most of these were interhemispheric, parietal, or temporal. SDH present on the first MRI persisted beyond 28 days of life in 8 infants. There was no demonstrable relationship between SDH and hypoxia. CONCLUSIONS: Asymptomatic SDH is common in young infants with congenital heart disease, at a frequency similar to that of those without congenital heart disease. These SDHs may occur in locations where they occur in abusive head trauma, but they are typically small and resolve within 3 months of birth. We were unable to demonstrate any association between hypoxia and SDH in this cohort. </jats:sec

Pre-Operative Brain Injury in Newborn Infants With Transposition of the Great Arteries Occurs at Rates Similar to Other Complex Congenital Heart Disease and Is Not Related to Balloon Atrial Septostomy

ObjectivesThe goal of this study was to determine the prevalence and pattern of pre-operative brain injury in infants with transposition of the great arteries (TGA) compared with other complex congenital heart disease (CHD) and to define the risk of balloon atrial septostomy (BAS) for the development of brain injury.BackgroundIt has recently been suggested that infants with TGA are at increased risk of pre-operative brain injury, in particular, stroke, and that this is strongly associated with having a BAS.MethodsSixty-four newborn infants with TGA (n = 44), hypoplastic left heart syndrome (n = 13), or pulmonary atresia (n = 7) had magnetic resonance imaging (MRI) scans performed before surgery.ResultsThirty-three (75%) of the infants with TGA had a BAS. Brain injury occurred in 19 (30%) infants: white matter injury (WMI) in 17 (27%), and stroke in 3 (5%). There was no difference in the prevalence or pattern of brain injury between diagnostic groups. There was no association between BAS and brain injury in infants with TGA. There was a trend toward increased brain injury in TGA with an intact interventricular septum compared with TGA with a ventricular septal defect (38% vs. 8%, p = 0.075). There was no association between brain injury and any clinical variables.ConclusionsPre-operative brain injury on MRI scan was present in 30% of infants with CHD. The predominant pattern was WMI. The rates and patterns of pre-operative brain injury are similar in infants with TGA compared with other complex CHD, and BAS does not increase the risk of pre-operative brain injury

Identification and characterization of leukemia stem cells in murine MLL-AF9 acute myeloid leukemia

SummaryUsing a mouse model of human acute myeloid leukemia (AML) induced by the MLL-AF9 oncogene, we demonstrate that colony-forming cells (CFCs) in the bone marrow and spleen of leukemic mice are also leukemia stem cells (LSCs). These self-renewing cells (1) are frequent, accounting for 25%–30% of myeloid lineage cells at late-stage disease; (2) generate a phenotypic, morphologic, and functional leukemia cell hierarchy; (3) express mature myeloid lineage-specific antigens; and (4) exhibit altered microenvironmental interactions by comparison with the oncogene-immortalized CFCs that initiated the disease. Therefore, the LSCs responsible for sustaining, expanding, and regenerating MLL-AF9 AML are downstream myeloid lineage cells, which have acquired an aberrant Hox-associated self-renewal program as well as other biologic features of hematopoietic stem cells

Agreeing a set of biopsychosocial variables for collection across the UK Eating Disorders Clinical Research Network (EDCRN)

Background: Eating disorders are serious psychiatric disorders associated with high levels of co-occurring physical and mental health conditions, high rates of relapse and poor treatment outcomes. The collection of standardised, routinely collected data within clinical services holds promise to improve patient care. Proposals for standardised variables for collection in eating disorders services have been made, but not implemented, and have included limited biological measures. Given emerging evidence about the importance of metabolism and other biological factors in eating disorders, there is a need for such measures to be integrated into routine data collection. Objective: To agree on a set of biopsychosocial variables for routine data collection within eating disorder services in the United Kingdom. Methods: Two online workshops were conducted using an adapted nominal group technique to agree priorities for data collection in adult (n= 20) and child/adolescent (n=23) eating disorder services (n = 43 participants, comprised of people with lived experience, carers, clinicians and researchers). Two researchers independently conducted a reflexive thematic analysis of the workshop transcripts to identify qualitative priorities for data collection. Descriptive statistics were used to analyse the results of online voting. Measures and variables were chosen based on the priority-setting workshops, informed by prior work on psychometric properties of relevant measures. Findings: Thematic analysis identified four superordinate themes for data collection in eating disorder services: (1) a mutually valued and beneficial collaboration; (2) a holistic approach; (3) a balance between standardisation and individualisation; (4) doing no harm. Quantitative analysis of voting identified priorities across a range of domains Conclusions: This project agreed a set of biopsychosocial variables which have been implemented for routine data collection as part of the Eating Disorders Clinical Research Network. Further research should investigate the implementation of these variables for data collection in eating disorder services and identify priorities for data collection in under-represented groups such as people with experience of binge eating disorder. Clinical implications: Patients, caregivers, and clinicians support routine data collection in eating disorders services so long as the measures used are considered meaningful, not overly burdensome, non-stigmatising and collected as a collaboration between patients and treatment providers