W-S Chen

Primary vs. Delayed Resection for Obstructive Left-Sided Colorectal Cancer: Impact of Surgery on Patient Outcome

PurposeBy comparing surgical outcomes between primary and delayed resection, we addressed whether and how surgical strategies impacted prognosis of patients with left-sided colorectal cancer underwent emergency curative resection.MethodsBetween January 1980 and December 2002, a total of 143 patients were identified who presented with obstructive left-sided colorectal cancer and received emergency curative resection in Taipei Veterans General Hospital. Patients were stratified according to the timing of tumor resection into two groups: primary resection and delayed resection. Demographic data of the patients, characteristics of the tumors, and short-term and long-term outcomes were analyzed and compared between the two groups.ResultsThe demographic data and tumor characteristics did not differ between the two groups except for more rectal cancers in the delayed resection group (Pu2009=u20090.021). Primary resection group had a higher anastomotic leakage rate (Pu2009=u20090.017) and a trend toward a higher mortality rate, which did not reach statistical significance (Pu2009=u20090.063). The median follow-up intervals were similar (60.4 vs. 58.3xa0months; Pu2009=u20090.79). The median survival tended to be longer in delayed resection group (66 vs. 105xa0months; Pu2009=u20090.088). Overall five-year and ten-year survival for primary resection were 43.7 and 31.9 percent, respectively, compared with 67.2 and 53.2 percent, respectively, for delayed resection.ConclusionsDelayed resection seems to be a safer procedure and provided a better oncologic outcome compared with primary resection in obstructive left-sided colorectal cancer under emergency situations.

Incidence and risk analysis of aortic aneurysm and aortic dissection among patients with systemic lupus erythematosus: a nationwide population-based study in Taiwan

Objective The objective of our study was to determine the incidence rates and risk factors of aortic aneurysm and aortic dissection among patients with systemic lupus erythematosus (SLE) using a nationwide population-based data set. Methods We conducted a retrospective cohort study using data from the Taiwan National Health Insurance database. Patients with SLE and age-, sex- and comorbidity-matched control patients without SLE were identified. The primary endpoint was the first occurrence of aortic aneurysm or aortic dissection. The incidence rate ratios (IRRs) were calculated based on a 95% confidence interval (CI). A Cox proportional-hazards model was used to evaluate the risk factors for aortic aneurysm and aortic dissection in the SLE cohort. Results Among the 15,209 patients with SLE (89.9% women and mean age of 38.3 years), 20 developed aortic aneurysm and 13 developed aortic dissection (overall incidence rate, 4.26 per 10,000 person-years). Compared with the control patients, the overall IRR for developing aortic aneurysm or aortic dissection was 3.34 (95% CI, 1.71–6.91; pu2009<u20090.001). The IRRs for aortic aneurysm or aortic dissection were 2.98 (95% CI, 1.41–6.70, pu2009=u20090.018) for women and 5.50 (95% CI, 1.10–53.15, pu2009=u20090.020) for men. Multivariate Cox regression analysis showed that age, male sex, an SLE diagnosis greater than three years prior and hypertension were associated with aortic aneurysm and aortic dissection. Conclusion Aortic aneurysm and aortic dissection occur at higher rates in SLE patients than in people without SLE and a longer disease duration is associated with a higher risk of these rare vascular complications.

Risk of infective endocarditis in patients with systemic lupus erythematosus in Taiwan: a nationwide population-based study

Objectives Patients with systemic lupus erythematosus are considered vulnerable to infective endocarditis and prophylactic antibiotics are recommended before an invasive dental procedure. However, the evidence is insufficient. This nationwide population-based study evaluated the risk and related factors of infective endocarditis in systemic lupus erythematosus. Methods We identified 12,102 systemic lupus erythematosus patients from the National Health Insurance research-oriented database, and compared the incidence rate of infective endocarditis with that among 48,408 non-systemic lupus erythematosus controls. A Cox multivariable proportional hazards model was employed to evaluate the risk of infective endocarditis in the systemic lupus erythematosus cohort. Results After a mean follow-up of more than six years, the systemic lupus erythematosus cohort had a significantly higher incidence rate of infective endocarditis (42.58 vs 4.32 per 100,000 person-years, incidence rate ratiou2009=u20099.86, pu2009<u20090.001) than that of the control cohort. By contrast, the older systemic lupus erythematosus cohort had lower risk (adjusted hazard ratio 11.64) than that of the younger-than-60-years systemic lupus erythematosus cohort (adjusted hazard ratio 15.82). Cox multivariate proportional hazards analysis revealed heart disease (hazard ratiou2009=u20095.71, pu2009<u20090.001), chronic kidney disease (hazard ratiou2009=u20092.98, pu2009=u20090.034), receiving a dental procedure within 30 days (hazard ratiou2009=u200936.80, pu2009<u20090.001), and intravenous steroid therapy within 30 days (hazard ratiou2009=u200939.59, pu2009<u20090.001) were independent risk factors for infective endocarditis in systemic lupus erythematosus patients. Conclusions A higher risk of infective endocarditis was observed in systemic lupus erythematosus patients. Risk factors for infective endocarditis in the systemic lupus erythematosus cohort included heart disease, chronic kidney disease, steroid pulse therapy within 30 days, and a recent invasive dental procedure within 30 days.

Invasive aspergillosis in patients with systemic lupus erythematosus: a retrospective study on clinical characteristics and risk factors for mortality

Objective The objective of this paper is to analyze the clinical features, outcomes, mortality risk factors, and all-cause mortalities of invasive aspergillosis (IA) in patients with systemic lupus erythematosus (SLE). Methods Medical records were reviewed to identify SLE patients with IA from January 2006 to June 2017, at Taipei Veterans General Hospital, Taiwan. A total of 6714 SLE patients were included. Clinical/laboratory parameters and treatment outcomes were analyzed. Results Four patients (19.0%) had definite and 17 had probable (81.0%) IA. Seven patients (33.3%) survived and 14 died (66.7%). Concurrently, there were 19 pneumonias (90.5%), 17 cases of other infections (81.0%), eight bacteremia (38.1%), nine cytomegalovirus (CMV, 42.7%) and six Candida (28.6%) infections. In all 55 blood cultures, 38 (69.1%) yielded gram-negative bacilli, of which carbapenem-resistant A. baumannii accounted for eight (21.1%); 17 (30.9%) yielded gram-positive cocci, of which methicillin-resistant S. aureus accounted for six (35.3%); and vancomycin-resistant Enterococcus accounted for four (23.5%). Daily steroid doseu2009≥u200920u2009mg (hazard ratio (HR) 2.00), recent pulse steroid therapy (HR 2.80), azathioprine (HR 2.00), rituximab (HR 2.00), plasmapheresis (HR 2.00), acute respiratory distress syndrome (HR 2.00), concurrent infections (HR 5.667) and CMV viremia (HR 1.75) were higher in the fatality group. All p values were less than 0.05. Septic shock (nu2009=u20097, 50% in the fatality group) is the most common cause of mortality. Conclusions High daily steroid dosing, recent pulse steroid therapy, azathioprine, rituximab, concurrent infections, and CMV viremia were mortality risk factors for IA in SLE.

FRI0381 Increased risk of osteoporotic fractures in adult patients with polymyositis and dermatomyositis: a nationwide population-based cohort study

Background Patients with polymyositis and dermatomyositis (PM/DM) are characterized by chronic muscle weakness due to autoimmune-mediated myositis and are usually treated with corticosteroids initially. PM/DM patients prone to develop osteoporosis and subsequent fractures but are rarely investigated. Objectives To explore the incidence rate (IR) and risk factors of osteoporotic fractures (OFs) among adult PM/DM patients. Methods We conducted a cohort study by utilizing the Taiwan National Health Insurance database. PM/DM patients and respective age- and gender-matched cohort without PM/DM were enrolled. The primary endpoint was the initial event of OFs. We used the Cox proportional hazard model to study the risk factors of OFs in the PM/DM cohort. Results Among 2391 PM/DM patients (67.8% female, mean age: 49.5 years) followed for a mean (SD) of 6.1 (5.0) years, 116 developed vertebral fractures, 32 had hip fractures, and 14 experienced radius fractures (IR: 8.18, 2.20, and 0.96 per 1000 person-years, respectively, Table 1). Compared with the matched cohort, the PM/DM patients had higher IR ratios (IRRs) (95% CIs) of OFs at all age groups at enrollment: 3.27 (2.19 to 4.81, p<0.0001) for people <50 years and 2.29 (1.85 to 2.82, p<0.0001) for those ≥50 years. The IRRs were 2.39 (1.92 to 2.94, p<0.0001) for vertebral fractures and 1.62 (1.07 to 2.38, p=0.0093) for hip fractures. PM/DM patients experienced vertebral fractures and hip fractures at younger ages (62.2 vs 68.4 and 66.0 vs 75.4 years, respectively; both p<0.001). Multivariable Cox regression analyses showed that being female gender, age ≥50 years, having hypertension, coronary artery disease, asthma, and using daily prednisolone equivalent to >5 mg are associated with OFs.Table 1. IRs and IRRs of osteoporotic fractures: overall and subgroup analysis Subgroup IM IR Control IR IRR (95% CI) p Value Overall fracture 10.90 5.23 2.08 (1.73 to 2.49) <0.0001 u2003Age <50 year 4.51 1.38 3.27 (2.19 to 4.81) <0.0001 u2003Age ≥50 year 22.59 9.85 2.29 (1.85 to 2.82) <0.0001 Vertebral fracture 8.18 3.43 2.39 (1.92 to 2.94) <0.0001 u2003Age <50 year 3.39 0.98 3.47 (2.17 to 5.44) <0.0001 u2003Age ≥50 year 16.82 6.33 2.66 (2.07 to 3.39) <0.0001 Hip fracture 2.20 1.36 1.62 (1.07 to 2.38) 0.0093 u2003Age <50 year 0.65 0.10 6.56 (1.75 to 24.6) 0.0027 u2003Age ≥50 year 4.87 2.83 1.72 (1.09 to 2.62) 0.0081 Radius fracture 0.96 0.83 1.15 (0.60 to 2.02) 0.3081 u2003Age <50 year 0.43 0.35 1.25 (0.31 to 3.69) 0.3289 u2003Age ≥50 year 1.86 1.40 1.35 (0.62 to 2.63) 0.1857 IR, incidence rate per 1000 person-year; IRR, incidence rate ratio; CI, confidence interval. Conclusions Adult PM/DM patients had a high IR of vertebral and hip fractures. Patients who were female, advanced age, having certain comorbidities, and exposed to corticosteroid exhibited a higher risk. Disclosure of Interest None declared

SAT0566 Salivary Gland Ultrasonography and Its Applications in Patients with Sjögren's Syndrome and Sicca Symptoms

Background Sjögrens syndrome is an autoimmune disease that involves the exocrine glands. In the criteria declared in 2002 and 2012, salivary gland biopsy remains crucial in diagnosing the disease, and the aggregation of lymphocytes correlates with the disease activity. However, salivary gland biopsy is invasive and is not recommended for monitoring the disease activity. Ultrasonography provides easy access, low cost and real-time image. Recent systemic review indicated ultrasonography revealing abnormalities of salivary glands, which may be helpful for rheumatologist in diagnosing Sjögrens syndrome, but the reliabilities need to be confirmed among different scoring systems. Objectives To investigate the usefulness of salivary gland ultrasonography in Sjögrens syndrome and its correlations with EULAR Sjögrens Syndrome Patient Reported Index (ESSPRI) questionnaires (Seror R, 2011). Methods 50 patients, including primary and secondary Sjögrens syndrome, as well as some patients with sicca symptoms were enrolled. Ultrasonography by a 13MHz linear probe was performed at parotid and submandibular glands. Each gland was scored from 0 to 4 according to the criteria proposed by previous study (Takagi Y, 2010), with a total maximum score with 16. ESSPRI questionnaires and blood samplings were also performed within 1 week after ultrasonography. Results Total 31 primary Sjögrens Syndrome, 8 secondary Sjögrens Syndrome, and 13 patients with sicca symptoms were enrolled. The average score of salivary gland ultrasonography was 8, 8, 5 respectively in each group. A significant correlations between salivary gland ultrasonography summation score with serum anti-La (SSB) (p=0.006) and ESSPRI score (p<0.001) were noted. The score also correlated with the fatigue score (p<0.001) and dry score (p=0.001) in the ESSPRI questionnaire, but not with the pain score (p=0.135). The correlations with serum anti-Ro antibody was not significant (p=0.902). Conclusions Summation score of salivary gland ultrasonography correlated well with serum anti-La titers and ESSPRI score. Ultrasonography provided real-time, easily accessible information on patients salivary gland conditions, as well as good correlations with patients subjective discomfort. The relationship between the ultrasonography images and disease activity deserves further investigations. References Jousse-Joulin S, et al. Rheumatology (Oxford). 2015. [Epub ahead of print] Takagi Y, et al. Ann Rheum Dis 2010;69:1321–4. Seror R, et al. Ann Rheum Dis 2011;70:968–72. Disclosure of Interest None declared

FRI0242 Disease Burden of Ankylosing Spondylitis in Taiwan: A Population-Based Analysis

Background Ankylosing spondylitis (AS) is a form of arthritis that affects the spine. The spinal joints are inflamed causing severe pain and discomfort. Severe effects of AS can include new bone formation on the spine causing immobility. It is associated with decreased quality-of-life in its patients, and pharmacological and non-pharmacological treatments are available. Objectives This research aims to estimate the economic burden of AS in Taiwan. Methods The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99% of Taiwans population, was utilized. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified AS patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to AS. We used a micro-costing approach for direct health care costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, lab tests, and drugs. Costs were presented in 2014 USD (1 USD =30.09 TWD). Results A total of 12,783 AS patients were included in the database with incremental total direct cost of

602PKynurenine 3-monooxygenase as a potential biomarker for colorectal cancer

18,002,445 due to AS. This resulted in an average incremental direct cost of

534PPatterns of germline and somatic mutations in 16 mismatch repair associated genes analyzed with next generation sequencing (NGS) in colorectal cancer with EMAST (+) and/or MSI-high

1,408 per AS patient. Within direct costs, the largest burdens were associated with medication (

531PThe clinical features and genomic landscape of elevated microsatellite alterations at selected tetranucleotide repeats (EMAST) in patients with colorectal cancer

15,884,949; 88.24%), lab tests (