Academic literature on the topic '629.892 4019'

4010 Background: The phase 3 KEYNOTE-181 study compared pembrolizumab (pembro) vs chemo as second-line therapy for patients (pts) with advanced/metastatic squamous cell carcinoma (SCC) and adenocarcinoma (ACC) of the esophagus (NCT02564263). Methods: Eligible pts were randomized 1:1 to pembro 200 mg Q3W for up to 2 years or choice of paclitaxel, docetaxel, or irinotecan. Randomization was stratified by histology (SCC vs adenocarcinoma) and region (Asia vs rest of world). Primary end points were OS in the SCC, PD-L1 combined positive score (CPS) ≥10, and the ITT. Secondary endpoints included PFS, ORR, safety; exploratory endpoints included health-related quality of life (HRQoL) in CPS ≥10. Results: 628 pts were randomized (401 with SCC; 222 with CPS ≥10). As of Oct. 15, 2018, median follow-up was 7.1 mo (pembro) vs 6.9 mo (chemo). In CPS ≥10, OS was superior with pembro vs chemo (median 9.3 vs 6.7 mo; HR 0.69; 95% CI 0.52-0.93; P= 0.0074). In CPS ≥10 SCC, median OS was 10.3 mo vs 6.7 mo and in CPS ≥10 ACC, median OS was 6.3 mo vs 6.9 mo; 12-mo OS rates were higher with pembro vs chemo (Table). In SCC, median OS was 8.2 mo vs 7.1 mo; HR 0.78; 95% CI 0.63-0.96; P= 0.0095. In the ITT, median OS was 7.1 mo vs 7.1 mo; HR 0.89; 95% CI 0.75-1.05; P= 0.0560. Updated OS will be presented. Grade 3-5 drug-related AEs (≥10% incidence in either arm) included decreased white blood cells (0% vs 10%), decreased neutrophils (0.3% vs 10%). In CPS ≥10, HRQoL improved with pembro vs chemo only for EQ-5D VAS (difference in LS mean change from baseline 5.57; 95% CI 0.58-10.56). Conclusions: Pembro significantly improved OS vs chemo as second-line therapy for advanced esophageal cancer with PD-L1 CPS ≥10, with a more favorable safety profile and stable and similar QOL. These data support pembro as a new second-line standard of care for esophageal cancer with PD-L1 CPS ≥10. Clinical trial information: NCT02564263. [Table: see text]

PURPOSE Patients with advanced esophageal cancer have a poor prognosis and limited treatment options after first-line chemotherapy. PATIENTS AND METHODS In this open-label, phase III study, we randomly assigned (1:1) 628 patients with advanced/metastatic squamous cell carcinoma or adenocarcinoma of the esophagus, that progressed after one prior therapy, to pembrolizumab 200 mg every 3 weeks for up to 2 years or chemotherapy (investigator’s choice of paclitaxel, docetaxel, or irinotecan). Primary end points were overall survival (OS) in patients with programmed death ligand-1 (PD-L1) combined positive score (CPS) ≥ 10, in patients with squamous cell carcinoma, and in all patients (one-sided α 0.9%, 0.8%, and 0.8%, respectively). RESULTS At final analysis, conducted 16 months after the last patient was randomly assigned, OS was prolonged with pembrolizumab versus chemotherapy for patients with CPS ≥ 10 (median, 9.3 v 6.7 months; hazard ratio [HR], 0.69 [95% CI, 0.52 to 0.93]; P = .0074). Estimated 12-month OS rate was 43% (95% CI, 33.5% to 52.1%) with pembrolizumab versus 20% (95% CI, 13.5% to 28.3%) with chemotherapy. Median OS was 8.2 months versus 7.1 months (HR, 0.78 [95% CI, 0.63 to 0.96]; P = .0095) in patients with squamous cell carcinoma and 7.1 months versus 7.1 months (HR, 0.89 [95% CI, 0.75 to 1.05]; P = .0560) in all patients. Grade 3-5 treatment-related adverse events occurred in 18.2% of patients with pembrolizumab versus 40.9% in those who underwent chemotherapy. CONCLUSION Pembrolizumab prolonged OS versus chemotherapy as second-line therapy for advanced esophageal cancer in patients with PD-L1 CPS ≥ 10, with fewer treatment-related adverse events.

Introduction. Identification of the groups of the population most susceptible to infection with hepatitis A virus (HAV) is a key component for the regulation of anti-epidemic measures during the activation of the epidemic process. The aim аssessment of the herd immunity to hepatitis A (HA) among different age groups of the population of the Republic of Tatarstan. Materials and methods. The analysis of the HA incidence of from 2006 to 2021 and the study of herd immunity to HA among 6,553 persons from different age groups that were not vaccinated against HA were carried out. Participants with protective concentrations of antibodies to HAV of 20 mMU/ml or more were considered as seropositive. Results. The analysis showed a low intensity of the epidemic process in general (3.6 0.3о/оооо), while the HA incidence among children and adults was significantly different, with incidence rates 2.3 times higher in the first group (6.9 0.9 and 3.0 0.3о/оооо, respectively). The epidemic process is determined by persons aged 1517 years (8.2 2.5о/оооо), 36 years (7.0 1.9о/оооо, 714 years (6.2 1.3о/оооо), the incidence among these age groups in all observed years remained the highest. In general, the proportion of seropositive children was 32.1 1.0%. Among adults, anti-HAV IgG antibodies in a protective concentration was detected in 68.2 0.7%. The highest frequency of anti-HAV IgG positive samples was observed among persons aged 5059 years 89.4 1.1%, in age group 4049 years 73.5 1.2%, in age group 3039 years 65.5 1.3%, and in age group 2029 years 48.2 1.6%. In total, 56.9 0.6% of the examined individuals had protective antibodies to HAV. The detection rates of anti-HAV IgG antibodies were significantly different in all age groups (p 0.05).

AbstractThe Ganjiang River, one of eight major tributaries of the Yangtze River, located in the western hinterland of the Cathaysia Block, SE China, has a length of 823 km and a drainage area of 82 809 km2, whose detrital zircons provide a valuable means to trace sediment provenances of the river and explore the crustal growth and evolution of the Cathaysia Block. In the current study, 389 concordia zircon U–Pb age spots and rare earth element (REE) contents, in combination with 201 Lu–Hf isotope analyses, have been determined. Oscillatory zoning, high Th/U ratios and REE distribution patterns indicate that most detrital zircon grains are of magmatic origin. The age can be further divided into seven groups: 130–185 Ma with a peak at 153 Ma (7 %); 217–379 Ma with a peak at 224 Ma (16 %); 390–494 Ma with a peak at 424 Ma (37 %); 500–698 Ma with a peak at 624 Ma (5 %); 716–897 Ma with a peak at 812 Ma (10 %); 902–1191 Ma with a peak at 976 Ma (13 %); and 2232–2614 Ma with a peak at 2471 Ma (5 %). The sources of almost all the zircon age groups can be found from the exposed rocks. In particular, Yanshanian, Hercynian to Indosinian, Pan-African, Grenvillian and Palaeoproterozoic–Archaean zircons can be mainly sourced from the northern Guangdong – southern Jiangxi – western Fujian region, while Caledonian zircons come from southern and central Jiangxi, and Jinningian zircons are from central and northern Jiangxi. Most determined zircon grains exhibit negative εHf(t) values and TDM2 ages of 797 to 4016 Ma with a wide peak at 1500–2100 Ma and a keen peak at 1824 Ma, suggesting that most zircons are sourced from the reworked ancient crustal materials or crust–mantle mixing. The zircon Hf model age cumulative probability diagram shows that rapid crustal growth took place at the Palaeo- to Mesoproterozoic and that about 90 % of the crust of the Cathaysia Block was formed before 1.5 Ga.

ImportanceThe introduction of direct oral anticoagulants (DOACs) has transformed the treatment of venous thromboembolism (VTE). Large health care databases offer valuable insight into how oral anticoagulants (OACs) are used in clinical practice and may aid in understanding reasons for changes in therapy.ObjectivesTo evaluate prescribing patterns of OACs for patients with VTE and identify clinical events that precede treatment changes.Design, Setting, and ParticipantsThis retrospective cohort study used data from a public (Medicare fee-for-service) and a commercial (IBM MarketScan) health insurance database on 298 609 patients initiating OACs within 90 days of index VTE hospitalization from January 1, 2009, to December 31, 2020. Statistical analysis was conducted from April to August 2022.ExposuresWarfarin and the DOACs rivaroxaban, apixaban, dabigatran, and edoxaban.Main Outcomes and MeasuresCharacteristics of patients initiating different OACs, along with trends over time of patients initiating OACs, were compared. Time receiving continuous anticoagulant therapy, patterns of anticoagulant discontinuation (treatment gap of ≥30 days), and treatment switches were assessed. Clinical events in the 30 days preceding treatment modifications were identified.ResultsA total of 203 378 individuals with Medicare (mean [SD] age, 76.9 [7.6] years; 122 554 women [60.3%]) and 95 231 with commercial insurance (mean [SD] age, 57.6 [15.8] years; 47 139 women [49.5%]) were included (N = 298 609). Warfarin was the most frequent OAC prescribed (163 044 [54.6%]), followed by rivaroxaban (66 882 [22.3%]) and apixaban (65 997 [22.1%]). The proportion of patients initiating DOACs increased from 0% in 2010 to 86.8% (22 420 of 25 817) in 2019 for patients with Medicare and 92.1% (4012 of 4357) in 2020 for commercially insured patients. Patients with chronic kidney disease were more likely to initiate warfarin (35 561 [11.9%]) or apixaban (16 294 [5.5%]) than rivaroxaban (10 136 [3.4%]), and those with a history of bleeding were more likely to initiate apixaban (5424 [1.8%]) than rivaroxaban (3007 [1.0%]). Overall, patients received persistent OAC treatment for approximately 6 months (Medicare: median, 175 days [IQR, 76-327 days]; commercial insurance: median, 168 days [IQR, 83-279 days]). A total of 33 011 patients (11.1%) switched anticoagulant therapy within a year. Switching to another anticoagulant was preceded most frequently by codes for a VTE diagnostic procedure (27.2% of all switchers [8983 of 33 011]).Conclusions and RelevanceThis cohort study using data from 2 US health insurance databases suggests that most patients with VTE continued oral anticoagulant treatment for approximately 6 months. Clinical reasons for modifying anticoagulant therapy were identified in one-third of patients. Identifying reasons for treatment modification is crucial for generating valid evidence on drug safety and effectiveness.

Abstract Background: Mutational testing of genes involved in DNA damage repair can help identify patients with metastatic triple-negative breast cancer (mTNBC) who might derive clinical benefit from poly (ADP-ribose) polymerase (PARP) inhibitors. We examined clinical characteristics and treatment patterns by BRCA1/2/ATM mutation status in patients with mTNBC receiving routine care in the United States.Methods: Included patients were aged ≥18 years with metastatic BC (≥2 BC diagnoses within 90 days and ≥1 diagnosis or ≥2 note mentions of metastatic disease) in Optum’s de-identified electronic health record (EHR) database (1/1/2013 - 6/30/2020; N=22.5M total lives). Index date was the first diagnosis/note mention of metastatic disease; TN status was based on ER, PR and HER2 negative test results in the 1-year baseline through 90 days post-index. We assessed baseline demographic, clinical and prognostic factors in the 12 months preceding the index date and followed for up to 36 months or until death.Results: A total of 3,017 patients with mTNBC were identified. Among 1,234 (40.9%) patients tested for BRCA/ATM mutation, 394 (31.9%) had a BRCA/ATM mutation (BRCA/ATMmut), 487 (39.5%) were negative for BRCA/ATMmut, and 353 (28.6%) had unknown BRCA/ATMmut status. BRCA/ATMmut patients had a mean age (SD) of 49.5 (12.9) years compared with 51.2 (12.1) years in patient with no BRCA/ATMmut. Racial distribution among patients with vs without BRCA/ATMmut was 73.1% vs 71.5% Caucasian, 15.5% vs 19.3% African American, 3.8% vs 1.2% Asian, and 7.6% vs 8.0% unknown, respectively. Among patients with BRCA/ATMmut, 22.1% had 2+ metastases, 11.4% had bone metastases, 5.6% had brain metastasis, 5.1% had liver metastasis, and 9.1% had lung metastasis. Among patients without BRCA/ATMmut, 18.5% had 2+ metastases, 9.4% had bone metastases, 5.7% had brain metastasis, 5.3% had liver metastasis, and 8.4% had lung metastasis. At 36-months post-index, the majority of patients had received an anthracycline (BRCA/ATMmut: 50.8%, no BRCA/ATMmut: 55.7%). The use of platinum-based therapies and PARP inhibitors was 23.2% and 9.7%, respectively in patients with BRCA/ATMmut; and 16.7% and 0.4%, respectively in patients without BRCA/ATMmut (table). Among Caucasian patients with BRCA/ATMmut, 12% had PARP inhibitor use compared to 0.0% of African American or Asian patients with BRCA/ATMmut. Conclusions: A 32% BRCA/ATM mutation rate in mTNBC was observed and access to PARP inhibitor use appeared to differ by race. The suboptimal BRCA testing rates observed among patients with mTNBC represent an important unmet need. Further research is needed to understand the barriers to optimal access to mutational testing and impacts on treatment choice and outcomes. Table. First-Line Regimens & Targeted Therapies by BRCA/ATM Status and RaceTreated PatientsAll (n=1,178)Caucasian (n=855)African American (n=240)Asian (n=21)BRCA/ATM TestingYesNoYesNoYesNoYesNo582(49.4%)596(50.6%)425(49.7%)430(50.3%)110(45.8%)130(54.2%)13(61.9%)8(38.1%)BRCA/ATMmut 185(31.8%)246(42.3%)142(33.4%)174(40.9%)29(26.4%)49(44.5%)5(38.5%)5(38.5%)Anthracycline-based therapy in 1st line50.8%55.7%49.3%54.6%58.6%63.3%40.0%20.0%Taxane therapy in 1st line9.2%7.3%8.5%6.3%13.8%8.2%0.0%0.0%Platinum-based therapy in any line/setting23.2%16.7%23.2%20.1%17.2%10.2%40.0%20.0%Immune Checkpoint Inhibitor in any line/setting7.0%7.3%7.7%8.6%6.9%4.1%0.0%20.0%PARP Inhibitor in any line/setting9.7%0.4%12.0%0.6%0.0%0.0%0.0%0.0% Citation Format: Gboyega Adeboyeje, Maria Sierra, Amy Bartels, Michelle Field, Sumit Jhamb, Ami Buikema, Seongjung Joo. Patient characteristics and treatment patterns by BRCA/ATM mutation status in patients with metastatic triple-negative breast cancer in the US: An electronic health records (EHR) based study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-11.

Background: Venous thromboembolism (VTE) occurs frequently in cancer patients and is commonly treated with therapeutic anticoagulation. Treatment of VTE in cancer patients with brain metastasis is an area of concern due to known risk of intracerebral hemorrhage (ICH). We evaluated risk of ICH in cancer patients with known brain metastases with or without anticoagulation. Methods: Cancer patients diagnosed with brain metastasis between 12/2005 and 7/2018 were identified using a radiation oncology database and electronic records were retrospectively reviewed. Patients with primary brain tumors and absence of follow-up brain imaging were excluded. Clinically significant ICH was defined as ICH resulting in focal neurologic deficit or requiring neurosurgery. Overall survival (OS) calculated from initial diagnosis of brain metastasis, estimated by the Kaplan-Meier method, and compared by the log-rank test. Predictors identified as statistically significant on univariate logistic regression analysis (p<0.05) were selected for multivariate analysis. Results: We identified 903 cancer patients with brain metastasis. Of these, 629 (69.7%) met inclusion criteria. Among all included patients, 130 (20.7%) received therapeutic anticoagulation (AC) [enoxaparin: n = 75 (57.7%), warfarin: n = 41 (31.5%), apixaban/rivaroxaban/fondaparinux: n = 7 (5.4%), and unfractionated heparin: n = 7 (5.4%)] due to VTE after diagnosis of brain metastasis, 499 (79.3%) patients did not receive AC. Patient baseline and treatment characteristics for both cohorts are shown in Table 1. Deep vein thrombosis and pulmonary emboli were identified in 133 (21.1%) and 77 (12.2%) patients respectively. ICH was recorded in 130 (20.7%) patients at the time of brain metastasis diagnosis. In the AC cohort, 22 of 130 (16.9%) patients had ICH, of which 13 (59.1%) clinically significant and 9 (40.9%) clinically insignificant at the time of brain metastasis diagnosis. In the no-AC cohort, 108 of 499 (21.6%) patients had ICH, of which 79 (73.1%) clinically insignificant and 29 (26.9%) clinically significant at the time of brain metastasis diagnosis. Median follow-up time of patients was 8.2 months. During the follow up time, ICH was detected in 14 (2.2%) patients overall, 12 (85.7%) patients were in the AC group and the other two (14.3) patients were in the no-AC group. Ten (71.4%) patients had clinically significant ICH. In univariable analysis, male gender [p = 0.001] and primary cancer subtype (melanoma and renal cell cancer vs others) [p = <.001] were predictors of ICH at the time of brain metastasis diagnosis. In multivariable analysis, both gender and primary malignancy subtype [p <0.001 and .007 respectively] remained statistically significant predictors of ICH at the time of brain metastasis diagnosis (Table 2). In multivariate analysis, only number of brain lesions was a predictor of clinically significant ICH at the time of brain metastasis diagnosis [p=.036]. In multivariate analysis, ICH at diagnosis, therapeutic ACs use, type of ACs, and duration of ACs were significant predictors of ICH after brain metastasis diagnosis [all p <.0001]. None of the patients who had ICH received heparin, 42.9% received warfarin, 35.7% received enoxaparin, and 7.1% received direct oral anticoagulant (DOACs) [p <.0001]. One-year OS of patients with brain metastasis who received anticoagulation and did not receive anticoagulation was 44% (95% CI: 36 - 54) and 49% (95% CI: 44 -54), respectively (p=0.5) (Figure 1A). One year OS of patients with brain metastasis who had ICH and did not have ICH was 42% (95% CI: 33 - 52) and 49% (95% CI: 45 - 54), respectively (p=0.05) (Figure 1B). Conclusion: In this cohort study, melanoma, renal cell cancer and male gender were significantly associated with increased risk of ICH. The use of therapeutic anticoagulation and history of ICH were associated with a greater risk of clinically significant ICH without affecting overall survival. About 88% of patients who had ICH during the follow up period received either warfarin or enoxparin. Larger studies are needed to better understand the safety profile of DOACs in this setting. Disclosures Khorana: Janssen: Consultancy; Bayer: Consultancy; Pfizer: Consultancy; Sanofi: Consultancy.

Abstract Introduction: Although highly effective agents and novel therapeutic strategies are being developed, high-dose chemotherapy followed by autologous stem cell transplantation (HDT/ASCT) has not been overcome in the first-line treatment for fit patients (pts) with multiple myeloma. The objective of this work is to retrospectively analyze the use of this procedure in newly diagnosed Czech patients. Methods: Data were derived using the Czech Myeloma Group Registry of Monoclonal Gammopathies. By February 2 nd 2021, a total of 2154 newly diagnosed multiple myeloma patients who underwent HDT/ASCT were identified. Results: At the time of multiple myeloma diagnosis, the median age was 59 years; 24%/56%/14%/5%/1% pts were ECOG 0/1/2/3/4; 44%/32%/24% pts were ISS stage I/II/III; 14.5%/17.5%/68% and 84%/16% pts were Durie-Salmon stage I/II/III and subclassification A/B, respectively. The combinations of agents used in the induction regimen were proteasome inhibitor (PI), immunomodulatory drug (IMiD) and glucocorticoid (GC) in 28.5% (613/2154) pts; PI, GC and chemotherapy (CHT) in 24.8% (534/2154) pts; GC and CHT in 22,5% and IMiD, GC and CHT in 16.1% (346/2154). Other combination of drugs was used in 8.2% (177/2154) pts. It was registered that 3.7% (79/2154) induction regimens were switched to a different combination because of toxicity, patient's choice, poor peripheral venous access or other reasons. Single HDT/ASCT was performed in 77.3% (1665/2154) cases whereas tandem HDT/ASCT was given to 11.8% (254/2154) patients. In 10% (215/2154) cases, the transplantation technique was not specified. Nine percent (193/2154) patients were treated within a clinical study. The median progression free survival (mPFS) and the median overall survival (mOS) of the whole cohort was 28.9 and 92.1 months, respectively. Information about response to treatment before and after the high-dose therapy were available for 75.7% (1627/2154) and 92.2% (1987/2154) patients, respectively. Disease status at the time of HDT/ASCT was defined as stringent complete response (sCR) at 2.2% (36/1627), complete response (CR) at 11.9% (194/1627), very good partial response (VGPR) at 38.2% (621/1627), partial response (PR) at 40.9% (666/1627), minimal response (MR) at 3.6%, (58/1627), stable disease (SD) at 2.2% (36/1627), progressive disease (PD) at 1% (16/1627) patients. The overall response rate (ORR) on day 100 was 92.8% (sCR: 10.5% [209/1987], CR: 22.4% [446/1987], VGPR: 35% [696/1987], PR: 24.8% [493/1987], MR: 2.7% [54/1987], SD: 1.4% [27/1987], PD: 3.1% [62/1987]). We also performed a survival analysis of patients progressing up to 18 months after HDT/ASCT (n=1219) versus patients progressing in more than 18 months (n=935). The median OS was 41.5 versus 124.9 months, respectively. An analysis of the role of tandem HDT/ASCT in this real-world cohort will be presented at the conference. Conclusion: Globally as well as in the Czech Republic, HDT/ASCT is an important therapeutic approach in the first-line treatment of multiple myeloma. Our analysis of 2154 newly diagnosed transplant-eligible patients confirms high effectiveness - ORR of 92.8%, mPFS of 28.9 months, and long-term survival reaching mOS of 92.1 months. Disclosures Minarik: Amgen: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Takeda: Consultancy, Honoraria.

Aims, Objectives and BackgroundThere is evidence that COVID-19 ‘lockdowns’ may have contributed to increased non-accidental injury, domestic violence and self-harm related to deteriorating mental health. Internationally, there is also evidence that the diversion of health care resources may led to worse outcomes for patients presenting with major trauma. There has been no previous national evaluation of ‘lockdown’ measures impact on the characteristics, treatment pathways and outcomes of trauma patients in EnglandWe aimed to assess the impact of successive lockdowns on the volume, demographics, injury mechanism, severity, treatment and outcomes of major trauma in England.Method and DesignDemographic characteristics and clinical pathways of TARN eligible patients in the first lockdown (24th March to 3rd July 2020 inclusive) and second lock down (1st November 2020 to 16th May 2021 inclusive) were compared to equivalent pre-COVID-19 periods in 2018–2019.A segmented regression model predicting the weekly risk adjusted survival was estimated and a discontinuity in the gradient (trend) or intercept (level) of the fitted model was tested for at the weekly time point of implementation of each lockdown.Abstract 1427 Figure 1Strobe diagram for inclusion of study populationAbstract 1427 Figure 2Interrupted time series analysis assessing the impact of COVID restrictions on likelihood of survival (red horizontal lines indicate introduction and relaxation of ‘lockdown’ measures)Abstract 1427 Table 1Comparison of demographics ‘lockdown’ and pre-COVID periodsPeriodPeriod24Mar19 – 03Jul19 (comparator)24Mar20 – 03Jul20 (lockdown 1)Absolute change [percentage point change (95%CI)] p-value01Nov18 – 16May19 (comparator)01Nov20 – 16May21 (lockdown 1)Absolute change [percentage point change (95%CI)] p-valueTotal2224317510-4733 (-21%)p<0.0001‡41016382622754 (–6.7%)p<0.0001‡Age (years), Median (IQR)67.6 (46.5–83.1)70.9 (50.3–84.2)3.3 (2.4 to 4.2)p<0.000169.1 (48.7–83.6)73.1 (53.3–85.1)4 (3.5 to 4.2)<0.0001Age bands, n(%)Age< 1138 (0.6%)130 (0.7%)-8 [0.1(-0.04 to 0.030)] p=0.14281 (0.7%)234 (0.6%)-47 [0.1 (-0.2 to 0.04)]p=0.1979Age <16942 (4.2%)674 (3.8%)-268 [-0.4 (-0.8 to 0]p=0.05311444 (3.5%)1218 (3.2%)-226 [-0.3(-0.6 to – 0.1)p=0.0084Age 16 – 649561 (43%)6974 (39.8%)-2587 [-3.2(-4.1 to -2.2)P<0.000117173 (41.9%)13980 (36.5%)-3193 [-5.3(-6 to -5)]p<0.0001Age 65 and over11740 (52.8%)9862 (56.3%)-1878 [3.5 (2.5 to 4.5)]p<0.000122399 (54.6%)23064 (60.3%)665 [5.7(5 to 6.3)]P<0.0001Age 85 and over4610 (20.7%)4047 (23.1%)-563 [2.4(1.6 to 3.2)]p<0.00018903 (21.7%)9731 (25.4%)828 [3.7 (3.1 to 4.3)]p<0.0001Male, n(%)12316 (55.4%)9512 (54.3%)-2804 [-1 (-2 to -0.6)]p=0.037322146 (54%)19769 (51.7%)-2377 [-2.3 (-3 to -1.6)]<0.0001CCI*, n(%)CCI 09359 (42.1%)6220 (35.5%)-3139 [ -6.5 (-7.5 to -5.6)] p<0.000116665 (40.6%)12806 (33.5%)-3859 [-7.1(-7.8 to -6.5)]p<0.0001CCI 1 – 58538 (38.4%)6896 (39.4%)-1642 [1 (0.3 to 2)]p=0.042615899 (38.8%)15667 (40.9%)-232 [2.2 (1.5 to 2.9)]p<0.0001CCI 6 – 103032 (13.6%)3061 (17.5%)29 [3.8 (3.2 to 4.6)]p<0.00015987 (14.6%)6863 (17.9%)876 [3.3(2.8 to 3.8)]p<0.0001CCI > 10927 (4.2%)1024 (5.8%)97 [1.7(1.2 to 2.1)]p<0.00011648 (4%)2410 (6.3%)762 [2.3(2 to 2.6)]p<0.0001Not recorded387 (1.7%)309 (1.8%)-88 [0.2 (-0.2 to 0.3)]p=0.8513817 (2%)516 (1.3%)-301 [-0.6(-0.8 to -0.5)]p<0.0001MOI**: RTC, n(%)Car occupant1247 (30.7%)551 (20.4%)-696 [-10.4(-12.4 to -8.2)]p<0.00012485 (35.2%)1551 (31.3%)-934 [-3.9(-5.6 to -2.2)]p<0.0001Pedestrian661 (16.3%)288 (10.6%)-373 [-5.6 (-7.2 to -4)]p<0.00011629 (23.1%)962 (19.4%)-667 [-3.7(-5.1 to -2.2)]p<0.0001Motorcycles1196 (29.4%)711 (26.3%)-485 [-3.2(-5.3 to -1)]p<0.00011524 (21.6%)976 (19.7%)-548[ -1.9(-3.3 to -0.4)]p<0.0001Cyclist912 (22.4%)1139 (42.1%)227 [19.6(17.4 to 21.9)]p<0.00011315 (18.6%)1396 (28.2%)81 [9.5(8 to 11.1)]p<0.0001Other11 (0.3%)<9 ()-10 [ -0.2(-0.4 to -0.06)p=0.025131 (0.4%)10 (0.2%)-21 [-0.23(-0.4 to -0.04)]p=0.0281MOI: Intentional, n(%)Intentional assault130 (0.6%)88 (0.5%)-42 [-0.08 (-0.2 to 0.06)]p=0.2724227 (0.6%)175 (0.5%)-52 [-0.1(-0.2 to 0.002)]P=0.0570Self harm276 (1.2%)284 (1.6%)8 [0.4 (0.1 to 0.6)]p=0.0014525 (1.3%)562 (1.5%)37 [0.2 (0.02 to 0.3)]p=0.0223NAI63 (0.3%)27 (0.2%)-36 [-0.1(-0.2 to -0.03)]p=0.007297 (0.2%)90 (0.2%)-7 [-0.001(-0.07 to 0.07)]p=0.9701Shooting34 (0.2%)40 (0.2%)6 [0.08(-0.01 to 0.2)]p=0.082680 (0.2%)56 (0.1%)-24 [ -0.05(-0.1 to 0.001)]p=0.0979Stabbing450 (2%)312 (1.8%)-138 [-0.2(-0.5 to 0.03)]p=0.0816791 (1.9%)589 (1.5%)-202 [-0.4 (-0.6 to -0.2)]p<0.0001Blows1174 (5.3%)647 (3.7%)-527 [-1.6(-1.9 to -1.2)]p<0.00012059 (5%)1299 (3.4%)-760 [-1.6(-1.9 to -1.3)]p<0.0001Unintentional, n(%)Falls>2m2055 (9.2%)1757 (10%)-298 [0.8(0.2 to 1.4)]P=0.00753740 (9,1%)3528 (9.2%)-212 [0.1(-0.3 to 0.5)]p=0.6181Falls<2m13384 (60.2%)11314 (64.6%)-2070 [4.4 (3.5 to 5.4)]p<0.000125505 (62.2%)26203 (65.8%)698 [6.3 (5.6 to 6.9)]p<0.0001Sport449 (2%)320 (1.8%)-129 [-0.2 (-0.5 to 0.01]p=0.1697615 (1.5%)489 (1.3%)-126 [-0.2 (-0.4 to -0.006)]p=0.0079GCS bands , n(%)Mild19609 (88.2%)15449 (88.2%)4160 [0.1 (-0.6 to 0.7)]p=0.826435831 (87.4%)34051 (89%)-1780 [1.6 (1.2 to 2.1)]p<0.0001Moderate689 (3.1%)625 (3.6%)-64 [0.5(0.1 to 0.8)]p=0.00901333 (3.2%)1127 (2.9%)-206 [-0.3 (-0.5 to -0.06)]p=0.0135Severe955 (4.3%)765 (4.4%)-190 [0.1 (-0.3 to 0.5)]p=0.71361886 (4.6%)1464 (3.8%)-422 [-0.8(-1 to -0.5)]p<0.0001Not recorded990 (4.5%)671 (3.8%)-319 [ -0.6(-1 to -0.2)]p=0.00221966 (4.8%)1620 (4.2%)-346 [-0.6(-0.8 to -0.3)]p=0.0002ISS***, median (IQR)9 (9–18)9 (9–18)09 (9–18)9 (9–17)0ISS bands, n(%)ISS 1 – 84545 (20.4%)3062 (17.5%)-1483 [-3 (-4 to -2)]p=<0.00018266 (20.2%)7838 (20.5%)-428 [0.3(-0.2 to 0.9)]p=0.2457ISS 9 – 159290 (41.8%)7728 (44.1%)-1562 [2.4(1.4 to 3.3)]p<0.000117207 (42%)16969 (44.3%)-233 [2.4(1.7 to 3.1)]p<0.0001ISS >158408 (37.8%)6720 (38.4%)-1688 [5.6(-0.4 to 1.5)]p=0.239115543 (37.9%)13455 (35.2%)-2088 [-2.7 (-3.4 to -2)]p<0.0001ISS >253995 (18%)3127 (17.9%)-868 [-0.1(-0.9 to 0.7 )]p=0.79217521 (18.3%)6201 (16.2%)-1320 [-2.1(-2.6 to -1.6)]p<0.0001Body regions, n(%)Head AIS 3+5911 (26.6%)4670 (26.7%)-1241 [0.1 (-0.8 to 1)]p=0.830111128 (27.1%)9629 (25.2%)-1499 [ -2(-2.6 to -1.3)]p<0.0001Face AIS 3+63 (0.3%)41 (0.2%)-22 [-0.05 (-0.1 to 0.05)]p=0.341699 (0.2%)69 (0.2%)-30 [-0.06 (-0.1 to 0)]p=0.0618Chest AIS 3+4787 (21.5%)3915 (22.4%)-872 [8.3 (0.2 to 1.6)]<0.04508515 (20.8%)8075 (21.1%)-440 [0.3 (-0.2 to 0.9)]p=0.2337Abdomen AIS 3+872 (3.9%)690 (3.9%)-182 [0.02 (-0.3 to 0.4)]p=0.91771465 (3.6%)1179 (3.1%)-286 [-0.5 (-0.7 to -0.2)]p=0.0001Spine AIS 3+1985 (8.9%)1561 (8.9%)-424 [-0.01(-0.6 to 0.5)]p=0.97443784 (9.2%)3459 (9%)-325 [-0.2(-0.6 to 0.2)]p=0.3654Pelvis AIS 3+758 (3.4%)600 (3.4%)-158 [0.02(-0.3 to 0.4)]p=0.91841501 (3.7%)1386 (3.6%)-115 [-0.04(-0.3 to 0.2)]p=0.7802Limb AIS 3+5707 (25.7%)4892 (27.9%)-815 [2.3 (1.4 to 3.2)]p<0.000110719 (26.1%)10122 (26.5%)-597 [0.3(-0.3 to 0.9)]p=0.3053Other AIS 3+217 (1%)199 (1.1%)-18 [0.2 (-0.04 to 0.3)]p=0.1176375 (0.9%)396 (1%)21 [0.1 (-0.01 to 0.2]p=0.0836Polytrauma1622 (7.3%)1350 (7.7%)-272 [0.4 (-0.1 to 0.9)]p=0.11602984 (7.3%)2429 (6.3%)-555 [-0.9(-1.2 to 0.6)]p<0.0001*CCI Charlson Comorbidity Index**MOI Mechanism of injury***ISS Injury Severity Score‡chi square test for uniform distributionAbstract 1427 Table 2Comparison care pathways ‘lockdown’ and pre-COVID periodsPeriodPeriod24Mar19 – 03Jul19 (comparator)24Mar20 – 03Jul20 (lockdown 1)Absolute Change01Nov18 – 16May19 (comparator)01Nov20 – 16May21 (lockdown 2)Absolute Change1stHospital MTC9908 (44.5%)7376 (42.1%)-2532 [-2.4 (-3.4 to -1.4)]p<0.000118099 (44.1%)15928 (41.6%)-2171 [-2.5 (-3.2 to -1.8)]p<0.0001Treated at MTC11176 (50.2%)8256 (47.2%)-2920 [-3 (-4 to -2)]p<0.000120395 (49.7%)17852 (46.7%)-2543[-3 (-4 to -2.4)]p<0.0001Consultant ED8140 (36.6%)5562 (31.8%)-2578 [-4.8(-5.8 to -3.9)]p<0.000114779 (36%)12577 (32.9%)-2202 [-3.2 (-3.8 to -2.5)]p<0.0001CT within 1 hr5062 (31.9%)3992 (30.9%)-1070 [-0.9(-2 to 0.1)]p=0.09449203 (31.6%)7776 (27.1%)-1427 [-4(-5 to -3.7)]p<0.0001Whole body CT3348 (15.1%)3210 (18.3%)-138 [3 (2 to 4)]p<0.00016040 (14.7%)6417 (16.8%)377 [2 (1.5 to 2.5)]p<0.0001ICU stay3092 (13.9%)2208 (12.6%)-884 [-1.3(-1.9 to -0.6) ]p=0.00025591 (13.6%)3850 (10.1%)-1741 [-3.6(-4 to -3)]p<0.0001Mortality*1417 (7.1%)1316 (8.3%)-101 [1.2 (0.6 to 1.7)]p<0.00012916 (7.9%)2858 (8.1%)-58 [0.2 (-0.1 to 0.6)] p=0.2040Discharge destination, n(%)Home (own)13800 (62%)10484 (59.9%)-3316 [-2(-3.1 to -1.2)]p<0.000124961 (60.9%)23368 (61.1%)-1593 [-0.7 (-1.4 to -0.05)]p=0.0340Home (relative/carer)473 (2.1%)372 (2.1%)-101 [0 (-0.3 to 0.3)]p=0.9890974 (2.4%)852 (2.2%)-122 [-0.1(-0.4 to 0.06)]p=0.1653Mortuary*1501 (6.7%)1323 (7.6%)-178 [0.8(0.3 to 1.3)]p=0.00193086 (7.5%)2977 (7.8%)-109 [0.1 (-0.3 to 0.5)]p=0.5113No fixed abode75 (0.3%)47 (0.3%)-28 (-37.3%)107 (0.3%)87 (0.2%)-20 (-18.7%)Not Known87 (0.4%)39 (0.2%)-48 (-55.2%)101 (0.2%)95 (0.2%)-6 (-5.9%)Nursing Home1190 (5.3%)1063 (6.1%)-127 [0.7(0.3 to 1.2)]p=0.00202448 (6%)2231 (5.8%)-217 [-0.2(-0.6 to 0.1)]p=0.1620Other Acute hospital2425 (10.9%)1736 (9.9%)-689 [-0.1(-1.6 to -0.4)]p=0.00144346 (10.6%)3313 (8.7%)-1033 [-0.1(-0.5 to 0.2)]p=0.4115Other institution526 (2.4%)516 (2.9%)-10 [0.6 (0.3 to 0.9)]p=0.0003980 (2.4%)870 (2.3%)-110 [-0.1 (-0.3 to 0.1)]p=0.2817Rehabilitation2077 (9.3%)1871 (10.7%)-206 [1.3(0.7 to 1.9)]p<0.00013851 (9.4%)4274 (11.2%)423 [ 1.7(1.3 to 2.2)]p<0.0001Social care63 (0.3%)50 (0.3%)-13 [0 (-0.1 to 0.1)]p=0.9657121 (0.3%)103 (0.3%)-18 [-0.2(-0.1 to 0.5)]p=0.4939*These totals do not correspond as mortality includes deaths in the community and is censored at 30 daysResults and ConclusionThe first ‘lockdown’ had a larger associated reduction in total trauma volume (-21%) compared to the pre-COVID period than the second ‘lockdown’ (-6.7%). Trauma volume increased for those 65 and over (3%) and 85 and over (9.3%) during the second ‘lockdown’.There was a reduction in likelihood of survival (-1.71; 95% CI:-2.76 to -0.66) associated with the immediate introduction of the first ‘lockdown’. However, this was followed by a trend of improving survival (0.25; 95% CI: 0.14 to 0.35) and likelihood of survival returned to pre-pandemic levels by the end of the first ‘lockdown’ period.Future research is needed understand the initial reduction in likelihood of survival after major trauma observed with the implementation of the first ‘lockdown’ to prevent this occurring if measures re-introduced.

Abstract Background: Breast cancer screening (BCS) gaps have closed between non-Hispanic Black (NHB) and non-Hispanic White women when adjusted for covariates including insurance. However, gaps in breast cancer (BC) mortality persist. Washington DC and Baltimore (DC-Balt) are two high-resource cities with diverse populations, low BCS uptake, and high BC mortality. This analysis investigates the association between residence in a high NHB area and BCS uptake. Methods: This retrospective analysis used de-identified administrative data (2017–2019) from a large national US health insurer and publicly available demographic data. Included were adult (birth year 1957 to 1967) female members with a qualifying DC-Balt zip code, continuous coverage in a commercial fully insured plan, and 1+ evaluation and management (E&M) claims. Qualifying zip codes were Core Based Statistical Areas (CBSA) 47900 or 12580 per Housing and Urban Development Q1 2021 ZIP-CBSA data and zip code area type per 2019 Uniform Data System (UDS) Zip to zip code tabulation area (ZCTA) mapping. Study cohorts were created based on residence in an area of ≥40% NHB or &lt;40% NHB. Members with a BC diagnosis were excluded. A BCS outcome was identified by presence of digital mammography or digital breast tomosynthesis claims. Population data (NHB and total) by ZCTA was from American Community Survey (ACS) Table B03002 2019 5 Yr Estimates. Multiple regression analysis included the following covariates: a specific large regional employer (SLRE), member preventive care seeking beyond an E&M visit via the proxy of lipid panel claims, and healthcare systems (HCS) variation via one-shot encoded E&M visit claim from 12 top regional HCSs. Post-hoc sensitivity analysis examined correlation of high NHB to low household income (LHI &lt;$40k) per ACS Table B19001 and impact of LHI to regression. Results: After excluding 698 (5.0%) members with evidence of BC, 13,128 members met study criteria (22% ≥40% NHB, 78% &lt;40% NHB). Of those, 9,161 (70%)had BCS (61% ≥40% NHB, 72% &lt;40% NHB), 4,539 (35%) SLRE enrollment (48% ≥40% NHB, 30% &lt;40% NHB), 11,179 lipid claims (88% ≥40% NHB, 85% &lt;40% NHB), and 7,087 (57%) 1+ E&M visit at an identified HCS (65% ≥40% NHB, 51% &lt;40% NHB). OR for BCS given ≥40% NHB was 0.55 (CI 0.50-0.61). Covariate OR were 0.77 (CI 0.71-0.84) for SLRE plan enrollees and 3.92 CI (CI 3.54-4.34) for lipid screening. HCS E&M exposure OR were significant (p&lt;0.05) at 9 of 12 HCS. 7 HCS had higher OR and 2 lower OR. HCS OR ranged from 1.98 (CI 1.61-2.45) to 0.56 (CI 0.45-0.71). LHI was correlated with NHB ≥40% (r=0.29), but not significant in regression. LHI did not change significance or magnitude of NHB ≥40% or other covariates. Conclusion: Despite the Affordable Care Act’s mandate that most insured patients pay nothing out of pocket for BCS, insured women living in areas of Washington DC and Baltimore having higher minority populations are less likely to be screened than insured women living in lower minority population areas. This analysis suggests community-based outreach needs to target all women living in high minority population areas as disparities exist even among women with insurance. Multiple stakeholders (e.g. government, employers, healthcare providers, insurers, community support services) need to collaborate to reduce remaining barriers to BCS and actively facilitate this high value preventive care. Table 1.Cohort CharacteristicsNot Screened (N=3967) (30.2%)Screened (N=9161) (69.8%)Overall (N=13128)ZCTA NHB Pct0-20%2247 (56.6%)5983 (65.3%)8230 (62.7%)&gt;20-40%622 (15.7%)1501 (16.4%)2123 (16.2%)&gt;40-60%314 (7.9%)577 (6.3%)891 (6.8%)&gt;60-80%400 (10.1%)528 (5.8%)928 (7.1%)&gt;80-100%384 (9.7%)572 (6.2%)956 (7.3%)ZCTA LHI&lt;$40k Pct0-20%2684 (67.7%)6490 (70.8%)9174 (69.9%)&gt;20-40%1153 (29.1%)2399 (26.2%)3552 (27.1%)&gt;40-80%130 (3.3%)272 (3.0%)402 (3.1%)Lipid ClaimNo1098 (27.7%)851 (9.3%)1949 (14.8%)Yes2869 (72.3%)8310 (90.7%)11179 (85.2%)SLRENo2432 (61.3%)6157 (67.2%)8589 (65.4%)Yes1535 (38.7%)3004 (32.8%)4539 (34.6%)Any 12 HCSsNo1972 (49.7%)4069 (44.4%)6041 (46.0%)Yes1995 (50.3%)5092 (55.6%)7087 (54.0%) Citation Format: James Staib, Kierstin Catlett, Stacey Dacosta Byfield. Breast cancer screening disparities among insured women in the Washington DC-Baltimore area [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-07.

ЦЕЛЬ: изучить особенности клинической картины сахарного диабета (СД) 2 типа, коморбидного с ожи- рением и артериальной гипертерзией (АГ) у пациентов, поступающих в эндокринологическое отделение КОГБУЗ ККБ №7 г Киров для коррекции сахароснижающей терапии. МАТЕРИАЛЫ И МЕТОДЫ: изучали демографические, антропометрические данные, результаты лабо- раторных и инструментальных исследований, анализ коморбидности, медикаментозной терапии. Оценка результатов представлена в виде Ме [Q25;Q75]. РЕЗУЛЬТАТЫ: обследовано 65 пациентов с СД типа 2 и ожирением, из них мужчин 28 (43%), женщин 37 (57%). Возрастом от 41 до 69 лет, ИМТ – 33,9 [30;36,9] кг\м2. ОТ 107,5 [96;118] см без гендерных различий. АД систолическое 131,9 [120;140] мм рт ст, АД диастолическое 83,8 [80;90] мм рт ст, длительность АГ со- ставила 13,4 [10;15] лет. Длительность СД 2 типа – 8,0 [5;10] лет. Уровень НвА1с 8,5 [7;10,1]%, глюкоза нато- щак – 7,9 [6,0;9,6] ммоль/л, глюкоза постпрандиальная 13,6 [10,9;15,8] ммоль/л. При анализе неэффективной предшествующей сахароснижающей терапии выявлено, что инсулинотерапию получали 33 (51%) человек, из них на базис-болюсной терапии – 6 (18%), базальный инсулин в комбинации с пероральными сахарос- нижающими препаратами (ПССП) – 27 (82%), средняя суточная доза инсулина составила 44,7 [20;64] Ед, доза метформина – 2000 мг, Гликлазида – 66,9 [45,1;88,6] мг, Глимепирида 3 [1,8;3,8] мг, Глибенкламида 3,75 [3,1;4,4] мг, Вилдаглиптина 67,9 [50;100] мг, Ситаглиптина 80 [50,100] мг, Алоглиптина 25 [25;25] мг, Эмпаглифлозина 15,4 [10;21,8] мг, Дапаглифлозина 10 [10;10] мг, Лираглутида 1,3 [1,2;1,4] мг. При анализе ли- пидного профиля: уровень ОХС – 5,2 [3,7;6,4] ммоль/л, ЛПНП – 3,2 [2,2;4,1] ммоль/л, ТГ – 3,1 [1,4;3,5] ммоль/л, ЛПВП – 1,8 [1,2;1,9] ммоль/л. Статины на амбулаторном этапе получали 22 (34%) человек, из них средне-су- точная доза аторвастатина – 23,2 [20;35] мг, розувастатина – 15,4 [10;20] мг. Среди микрососудистых ослож- нений выявлены: ретинопатия у 14 (21,6%), непролиферативная у 12 (92,9%). Нефропатия у 22 (33,8%) паци- ентов: из них ХБП 1 – 8 (36,4%), ХБП 2 – 9 (40,9%), ХБП 3А – 5 (22,7%). Полинейропатия выявлена у 52 (80%) человек. Диабетическая макроангиопатия нижних конечностей выявлена у 28 (43,1%), цереброваскулярные заболевания – (30,8%), острые нарушения мозгового кровообращения – 2 (3,1%), ишемическая болезнь сердца – 13 (20%), острый инфаркт миокарда в анамнезе – 5 (7,7%), хроническая сердечная недостаточ- ность – 43 (66,2%). ВЫВОДЫ: у пациентов СД типа 2, ожирением и АГ, поступающих в стационар выявлена неэффек- тивность стандартных схем сахароснижающей терапии. Выявлено клинически значимое поражение как микро-, так и макрососудистого русла. Такой важный фактор, как диабетическая нефропатия выявлена у 76% пациентов, что ограничивает применения ряда препаратов. Таким образом, такая группа пациен- тов, требует более углубленного обследования, коррекции терапии и обязательного обучения в условиях круглосуточного стационара в связи с неэффективностью амбулаторного этапа лечения.