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To examine changes in lung function over time in extremely prematurely born adolescents.Changes in lung function during adolescence would vary by ventilation mode immediately after birth.Longitudinal follow-up study.Participants from the United Kingdom Oscillation Study who were randomized at birth to high-frequency oscillation (HFO) or conventional ventilation (CV) were assessed at 11-14 years (n = 319) and at 16-19 years (n = 159).Forced expiratory flow (FEF), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and lung volumes including functional residual capacity (FRC) were reported as z-scores. The diffusion capacity of the lungs for carbon monoxide (DLCO) was measured. Lung function trajectories were compared by mode of ventilation using mixed models. Changes in z-scores were scaled to 5-year average follow-up.There were significant changes in the mean FEF75, FEF50, FEF25, FEV1, FVC, and DLCO z-scores within the CV and HFO cohorts, but no significant differences in the changes between the two groups. The mean FRC z-score increased in both groups, with an average change of greater than one z-score. The mean FEV1/FVC z-score increased significantly in the CV group, but not in the HFO group (difference in slopes: p = 0.02). Across the population, deterioration in lung function was associated with male sex, white ethnicity, lower gestational age at birth, postnatal corticosteroids, oxygen dependency at 36 weeks postmenstrual age, and lower birth weight, but not ventilation mode.There was little evidence that the mode of ventilation affected changes in lung function over time.

Funding Acknowledgements Type of funding sources: None. Introduction In December 2019, a novel Coronavirus disease 2019 (COVID-19) was discovered and spread rapidly worldwide. The virus spared no country in its contagiousness. The most common clinical manifestations are respiratory symptoms; but COVID-19 may induce arrhythmias, myocardial infarction, heart failure, and other cardiovascular diseases due to the systemic inflammatory response coupled with localized vascular inflammation. The study aims to provide knowledge about the clinical profile, cardiovascular complications, and clinical outcomes among adult COVID-19 patients admitted to a tertiary hospital. Methods This study is a single-centered cross-sectional retrospective study of hospitalized adult COVID-19 patients between March 2020 to May 2022. COVID-19 confirmed patients who met the inclusion criteria with clinical data upon hospitalization are followed up for occurrence of critical illness. The study's primary outcome is determining the demographic profile and clinical course of COVID-19 infection regarding cardiovascular signs and symptoms. Data were retrieved from electronic health records. All outcomes were obtained with standardized data collection forms, and clinical severity was defined based on the National Institute of Health guidelines. Results A total of 1341 hospitalized adult COVID-19 patients were admitted with a mean age of 50.41±15.92 years. More males than females account for 60.2% of the total number of patients. Hypertension is the most common comorbidity among COVID-19 patients, comprising 44% of cases, followed by diabetes at 31.9% and dyslipidemia at 11.4%. About 5.4% had coronary artery disease, followed by heart disease 6 (3.6%) and arrhythmia (0.6%). Most COVID-19 patients were smokers 12% and alcoholic beverage drinkers (11.4%). A univariate analysis associated with mortality showed diabetes mellitus (odds ratio 2.7, p = 0.029) and hypertension (odds ratio 3.4, p = 0.11). In the multiple logistic regression analysis, factors' age (OR 1.095, estimate coefficient 0.091, standard error 0.028, p-value Conclusion Myocardial injury and significant cardiovascular risk factors increased mortality among critically-ill COVID-19 patients. Hence, aside from risk factor modification, emphasis on cardiovascular protection should also be considered during treatment for COVID-19.

BackgroundPeople with multimorbidity have complex healthcare needs. Some co-occurring diseases interact with each other to a larger extent than others and may have a different impact on primary care use.AimTo assess the association between multimorbidity clusters and primary care consultations over time.Design and settingA retrospective longitudinal (panel) study design was used. Data comprised electronic primary care health records of 826 166 patients registered at GP practices in an ethnically diverse, urban setting in London between 2005 and 2020.MethodPrimary care consultation rates were modelled using generalised estimating equations. Key controls included the total number of long-term conditions, five multimorbidity clusters, and their interaction effects, ethnic group, and polypharmacy (proxy for disease severity). Models were also calibrated by consultation type and ethnic group.ResultsIndividuals with multimorbidity used two to three times more primary care services than those without multimorbidity (incidence rate ratio 2.30, 95% confidence interval = 2.29 to 2.32). Patients in the alcohol dependence, substance dependence, and HIV cluster (Dependence+) had the highest rate of increase in primary care consultations as additional long-term conditions accumulated, followed by the mental health cluster (anxiety and depression). Differences by ethnic group were observed, with the largest impact in the chronic liver disease and viral hepatitis cluster for individuals of Black or Asian ethnicity.ConclusionThis study identified multimorbidity clusters with the highest primary care demand over time as additional long-term conditions developed, differentiating by consultation type and ethnicity. Targeting clinical practice to prevent multimorbidity progression for these groups may lessen future pressures on primary care demand by improving health outcomes.

Caustic agents, also called corrosive agents, could be acids or alkali in nature. If ingested, these agents can injure any part of the aerodigestive tree. Extent of injury depends on the type, concentration, duration of exposure and volume of caustic agent ingested. Serious complications after caustic agent ingestion can occur both in the short term such as hollow viscus perforation and death and in the long term such as stricture formation causing obstruction and lifetime risk of development of carcinoma.This is a case of a 25-year-old female who ingested an unknown substance resulting to a severe stricture of the larynx, hypopharynx, esophagus and pyloroantral region of the stomach. Six months after her tracheostomy and tube jejunostomy, she sought further medical attention in our institution due to inability to swallow food and saliva. She underwent pharyngolaryngectomy (PL) with the strictured esophagus and stomach left in-situ due to extensive adhesions. The subcutaneous colonic interposition reestablished the alimentary continuity by providing enough length for tension-free anastomosis and a more direct route for cervical anastomosis.Stricture formation is one of the most challenging late complication of corrosive injury. It results from scar formation in response to inflammation of the aerodigestive tract. Key factors in managing caustic strictures include safety of strictured segment resection, choice of replacement organ for reconstruction and route of conduit.Timing of surgery and proper selection the surgical procedure for complications of caustic ingestion can result in excellent long term outcomes.

Objective To compare central hemodynamics between white, black and Asian women in pregnancy. Methods This was a prospective, longitudinal study of maternal central hemodynamics in white, black and Asian women with a singleton pregnancy, assessed using a bioreactance method at 11 + 0 to 13 + 6, 19 + 0 to 24 + 0, 30 + 0 to 34 + 0 and 35 + 0 to 37 + 0 weeks' gestation. At each visit, cardiac output (CO), stroke volume (SV), heart rate (HR), peripheral vascular resistance (PVR) and mean arterial pressure were recorded. Multilevel linear mixed-effects analysis was performed to compare the repeated measures of the cardiac variables between white, black and Asian women, controlling for maternal characteristics, medical history and medication use. Results The study population included 1165 white, 247 black and 116 Asian women. CO increased with gestational age to a peak at 32 weeks and then decreased; the highest CO was observed in white women and the lowest in Asian women. SV initially increased after the first visit but subsequently declined with gestational age in white women, decreased with gestational age in black women and remained static in Asian women. In all three study groups, HR increased with gestational age until 32 weeks and then remained constant; HR was highest in black women and lowest in white women. PVR showed a reversed pattern to that of CO; the highest values were in Asian women and the lowest in white women. The least favorable hemodynamic profile, which was observed in black and Asian women, was reflected in higher rates of a small-for-gestational-age infant. Conclusions There are race-specific differences in maternal cardiac adaptation to pregnancy. White women have the most favorable cardiac adaptation by increasing SV and HR, achieving the highest CO and lowest PVR. In contrast, black and Asian women have lower CO and higher PVR than do white women, with CO increasing through a rise in HR due to declining or static SV. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Thermal maturity parameters have traditionally focused around the peak-oil window while parameters for the late- to post-oil window are not well constrained. Previous studies have shown that 3-ring polycyclic aromatic hydrocarbons (PAHs) can be used to correctly predict the maturity order for sedimentary organic matter. PAHs are structurally stable molecules and, when bound within kerogen, the kinetics of thermal alteration are slowed. The utility and preservation systematics of kerogen-bound 5-ring PAH, as measured by the 252 Da fragment ion, have not been studied in depth. These molecules have the potential to extend the sensitivity of maturity parameters into the late-oil window and beyond. Kerogen samples from five basins with a range of maturities and sedimentary environments were loaded with 5-wt% ammonium dioxydithiomolybdate [(NH4)2MoO2S2] and pyrolysed using catalytic hydropyrolysis (HyPy; 0C to 250C at 100C min-1 then 250C to 520C at 8C min-1) to extract covalently-bound compounds. Extracted compounds were analyzed by gas chromatography-mass spectrometry (GC-MS). The relative order of stability of kerogen-bound 5-ring PAH was shown to be perylene < benzo(a)pyrene < benzo(e)pyrene < benzofluoranthenes. The ratio of benzo(a)pyrene.benzo(e)pyrene (BaP/BeP) values range from 0.02 to 1.20. The ratio of perylene/benzo(e)pyrene (Per/BeP) values range from 0.01 to 0.65. Kerogen-bound benzo(a)pyrene was found to be most sensitive in the late-oil window. Kerogen-bound perylene was found to be most sensitive to change in the peak-oil window though still present at very low abundances in the most mature kerogen suite. The use of HyPy can release kerogen-bound 5-ring PAH to extend maturity parameters beyond the late-oil window, regardless of the sedimentary environment at the time of deposition.

Background Social and material deprivation accelerate the development of multimorbidity, yet the mechanisms which drive multimorbidity pathways and trajectories remain unclear. We aimed to examine the association between health inequality, risk factors and accumulation or resolution of LTCs, taking disease sequences into consideration. Methods We conducted a retrospective cohort of adults aged 18 years and over, registered between April 2005 and May 2020 in general practices in one inner London borough (n = 826,936). Thirty-two long term conditions (LTCs) were selected using a consensus process, based on a definition adapted to the demographic characteristics of the local population. sThe development and resolution of these LTCs were examined according to sociodemographic and clinical risk factors (hypertension; moderate obesity (BMI 30·0–39·9 kg/m2), high cholesterol (total cholesterol > 5 mmol/L), smoking, high alcohol consumption (>14 units per week), and psychoactive substance use), through the application of multistate Markov chain models. Findings Participants were followed up for a median of 4.2 years (IQR = 1·8 - 8·4); 631,760 (76%) entered the study with no LTCs, 121,424 (15%) with 1 LTC, 41,720 (5%) with 2 LTCs, and 31,966 (4%) with three or more LTCs. At the end of follow-up, 194,777 (24%) gained one or more LTCs, while 45,017 (5%) had resolved LTCs and 27,021 (3%) died. In multistate models, deprivation (hazard ratio [HR] between 1·30 to 1·64), female sex (HR 1·13 to 1·20), and Black ethnicity (HR 1·20 to 1·30; vs White) were independently associated with increased risk of transition from one to two LTCs, and shorter time spent in a healthy state. Substance use was the strongest risk factor for multimorbidity with an 85% probability of gaining LTCs over the next year. First order Markov chains identified consistent disease sequences including: chronic pain or osteoarthritis followed by anxiety and depression; alcohol and substance dependency followed by HIV, viral hepatitis, and liver disease; and morbid obesity followed by diabetes, hypertension, and chronic pain. Interpretation We examined the relations among 32 LTCs, taking the order of disease occurrence into consideration. Distinctive patterns for the development and accumulation of multimorbidity have emerged, with increased risk of transitioning from no conditions to multimorbidity and mortality related to ethnicity, deprivation and gender. Musculoskeletal disorders, morbid obesity and substance abuse represent common entry points to multimorbidity trajectories.

Background Sclerosing Epithelioid Fibrosarcoma (SEF) is a rare form of soft tissue sarcoma, often presenting in the soft tissues of the extremities. This tumor is characterized by slow growth, often with local recurrences and/or distant metastases. First described in 1995, subsequent case reports and case series have demonstrated that metastases are primarily to the lung, pleura and bone, but can occur anywhere. Treatment is primarily by wide excision and adjuvant chemotherapy or radiotherapy. However, treatment of this rare form of sarcoma is often unsatisfactory. Clinical case A 36-year-old female, had for 30 years presented with a slowly enlarging mass on the left axilla. She had no constitutional symptoms and had previously been in good health. She was first diagnosed with SEF when she presented with abdominal pain where workup showed elevated Lipase 8,098 U/L (73-393 U/L) and Amylase 976 U/L (25-115 U/L). CT scans showed an ill-defined hypodense focus in the body of the pancreas, with incidental findings of a mixed intensity ovoid lesion in the left erector spinae, and heterogeneously enhancing ovoid masses in the left axilla, left lateral chest wall, left lower lung lobe, and the liver. Biopsy of the left axillary mass showed a round cell sarcoma consistent with Sclerosing Epithelioid Fibrosarcoma. PET scan confirmed widespread metastases to the lungs, pancreas, abdominal wall, left thigh and scalp. She underwent wide excision of the masses in the left axilla, thigh, and scalp. Adjuvant chemotherapy with Doxorubicin and Ifosfamide was then initiated. 6 months after starting treatment, she reported a rapidly enlarging anterior neck mass. She denied tremors, palpitations, any change in weight, heat/cold intolerance, changes in bowel movement, fatigue or muscle weakness. On physical examination there was a 2×2 cm, firm, non-tender, palpable nodule on the right thyroid lobe. Thyroid function tests were as follows: TSH 0.52 uIU/mL (0.55-4.78 uIU/mL), FT4 1.27 ng/dL (0.89-1.76 ng/dL), FT3 2.84 pg/mL (2.30–4.20 pg/mL). On thyroid ultrasound there was a 2.6×1.8×2.4 cm, mixed hypoechoic, solid, lobulated nodule in the upper to middle third of the right thyroid lobe, and a 0.3×0.2×0.3 cm hypoechoic solid nodule in the lower third of the left thyroid lobe. FNAB showed hypercellular smears with atypical round to spindle-shaped cells arranged in singly and loose to crowded clusters. She underwent total thyroidectomy, and histopathologic examination was consistent with a multifocal metastatic Sclerosing Epithelioid Fibrosarcoma. She was subsequently started on Levothyroxine replacement. Conclusion This case, to our knowledge, is the first reported case of Sclerosing Epithelioid Fibrosarcoma (SEF) metastatic to the thyroid. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Deciding if and when might be the ‘optimal’ time for a person living with dementia to move to a care home is often difficult for the individual, family and practitioners. In this study, we describe the outcome of a factorial survey conducted with 100 dementia care practitioners (a frontline health or social care worker who works with people living with dementia) in England, which investigated factors used in deciding when a person living with dementia moves to a care home. Using findings from qualitative interviews with older people living with dementia, family carers, care home managers and social workers, we identified four factors that appeared to influence the decision to move to a care home: (1) Family carers’ ability to support the person with daily activities, (2) amount of support provided by home care workers, (3) level of risk of harm and (4) the person living with dementia's wishes. These factors were then randomised within skeleton vignettes that told the story of a fictitious woman (Jane) living with dementia at home with her husband. Fifty-four variations of the vignettes were produced and randomly assigned to 100 surveys. A total of 100 volunteer dementia care practitioners (78% female, 54% over 50 years of age) received their own personalised online survey link via email and were asked to read each vignette and decide whether to suggest Jane (a) move to a care home or (b) continue living at home. Results indicated that Jane's wishes principally drove most dementia care practitioners’ decision on whether to suggest a move to a care home or stay living at home (odds ratio = 6.5–19.5). Findings will inform a better understanding of the factors that contribute toward a decision to move to a care home and be of relevance to policy, practice, training and support.

Lung Function after High-Frequency Oscillation in Neonates Unlike the results published in 2014, these new data show no significant differences in lung function or behavioral outcomes in late adole...

Objective: To compare maternal hemodynamics and perinatal outcome, in pregnancies that do not develop pre-eclampsia (PE) or deliver a small-for-gestational-age (SGA) neonate, between those identified at 11–13 weeks' gestation as being screen positive or negative for preterm PE, by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and pregnancy associated plasma protein-A. Methods: This was a prospective longitudinal cohort study of maternal cardiovascular function, assessed using a bioreactance method, in women undergoing first-trimester screening for PE. Maternal hemodynamics and perinatal outcome were compared between screen-positive and screen-negative women who did not have a medical comorbidity, did not develop PE or pregnancy-induced hypertension and delivered at term a live neonate with birth weight between the 5 th and 95 th percentiles. A multilevel linear mixed-effects model was used to compare the repeated measures of cardiac variables, controlling for maternal characteristics. Results: The screen-negative group (n = 926) had normal cardiac function changes across gestation, whereas the screen-positive group (n = 170) demonstrated static or reduced cardiac output and stroke volume and higher mean arterial pressure and peripheral vascular resistance with advancing gestation. In the screen-positive group, compared with screen-negative women, birth-weight Z-score was shifted toward lower values, with prevalence of delivery of a neonate below the 35 th, 30 th or 25 th percentile being about 70% higher, and the rate of operative delivery for fetal distress in labor also being higher. Conclusion: Women who were screen positive for impaired placentation, even though they did not develop PE or deliver a SGA neonate, had pathological cardiac adaptation in pregnancy and increased risk of adverse perinatal outcome.

Background and purpose There is limited information on factors, trends, and outcomes in return to work at different time-points post-stroke; this study aims to identify these in a multi-ethnic urban population. Methods Patterns of return to work were identified in individuals in paid work prior to first-ever stroke in the population-based South London Stroke Register (SLSR) between 1995 and 2014. Multivariable logistic regression examined associations between patient characteristics and return to work at 1 year (1 y), 5 years (5 y) and 10 years (10 y) post-stroke. Results Among 5609 patients, 940 (17%) were working prior to their stroke, of whom 177 (19%) were working 3 months post-stroke, declining to 172 (18%) at 1 y, 113 (12%) at 5 y, and 27 (3%) at 10 y. Factors associated with return to work within 1 y, after logistic regression, included functional independence (BI ≥ 19; p Conclusion Although functionally independent stroke survivors are more likely to return to work long-term, a large proportion do not return to work despite functional independence. Return to work post-stroke is associated with improved long-term psychological outcomes and quality of life.

Objective To estimate the prevalence and determinants of multimorbidity in an urban, multi-ethnic area over 15-years and investigate the effect of applying resolved/remission codes on prevalence estimates. Study design and setting This is a population-based retrospective cross-sectional study using electronic health records of adults registered between 2005 –2020 in general practices in one inner London borough (n = 826,936). Classification of resolved/remission was based on clinical coding defined by the patient's general practitioner. Results The crude and age-adjusted prevalence of multimorbidity over the study period were 21.2% (95% CI: 21.1 –21.3) and 30.8% (30.6 –31.0), respectively. Applying resolved/remission codes decreased the crude and age-adjusted prevalence estimates to 18.0% (95% CI: 17.9 –18.1) and 27.5% (27.4 –27.7). Asthma (53.2%) and depression (20.2%) were responsible for most resolved and remission codes. Substance use (Adjusted Odds Ratio 10.62 [95% CI: 10.30 –10.95]), high cholesterol (2.48 [2.44 –2.53]), and moderate obesity (2.19 [2.15 –2.23]) were the strongest risk factor determinants of multimorbidity outside of advanced age. Conclusion Our study highlights the importance of applying resolved/remission codes to obtain an accurate prevalence and the increased burden of multimorbidity in a young, urban, and multi-ethnic population. Understanding modifiable risk factors for multimorbidity can assist policymakers in designing effective interventions to reduce progression to multimorbidity.

Background: Globally, there is increasing research on clusters of multimorbidity, but few studies have investigated multimorbidity in urban contexts characterised by a young, multi-ethnic, deprived populations. This study identified clusters of associative multimorbidity in an urban setting. Methods: This is a population-based retrospective cross-sectional study using electronic health records of all adults aged 18 years and over, registered between April 2005 to May 2020 in general practices in one inner London borough. Multiple correspondence analysis and cluster analysis was used to identify groups of multimorbidity from 32 long-term conditions (LTCs). Results: The population included 41 general practices with 826,936 patients registered between 2005 and 2020, with mean age 40 (SD15·6) years. The prevalence of multimorbidity was 21% (n = 174,881), with the median number of conditions being three and increasing with age. Analysis identified five consistent LTC clusters: 1) anxiety and depression (Ratio of within- to between- sum of squares (WSS/BSS