Risk factors for ophthalmic artery stenosis and occlusion in patients with retinoblastoma treated with intra-arterial chemotherapy

PurposeTo explore the risk factors for ophthalmic artery (OA) stenosis and occlusion after intra-arterial chemotherapy (IAC) with selective ophthalmic artery catheterisation (OAC) in the treatment of retinoblastoma.DesignRetrospective, single centre case-control study.MethodsThe study was conducted including consecutive patients with unilateral or bilateral intraocular retinoblastoma undergoing IAC between June 2016 and June 2019 with a follow-up time of 4 years. Main outcomes are rate of IAC-induced OA occlusion and OA diameter.Results346 attempted OAC infusions were successful. The total incidence of OA occlusion was 15.89%. The occlusion and control groups were similar in patients’ age, sex and disease stage. Median OA diameter was 0.49 mm in those with OA occlusion, and 0.66 mm in those without occlusion. In the occlusion group, the OA diameter difference was significantly larger between the first IAC and the final IAC (0.22mm vs 0.12mm, p=0.001). In both groups, the median number of IAC treatments was 3. Multivariate Cox regression models included initial OA diameter (OR: 0.005, p=0.001), ratio of OA orifice diameter differences between first and last IAC to the initial OA orifice diameter (OR: 4.661, p=0.003), and number of IAC (OR: 1.538, p=0.042) as clinical features significantly associated with OA occlusion.ConclusionsThe OA diameter at first IAC treatment, the ratio of OA orifice diameter differences between first and last IAC to the initial OA orifice diameter and total number of IAC treatments may be three main clinical predictors for OA occlusion after IAC for retinoblastoma.

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Risk of Pharmacological or Hospital Treatment for Depression in Patients with Colorectal Cancer–Associations with Pre-Cancer Lifestyle, Comorbidity and Clinical Factors

Cancers ◽

10.3390/cancers13081979 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1979

Author(s):

Trille Kristina Kjaer ◽

Ida Rask Moustsen-Helms ◽

Vanna Albieri ◽

Signe Benzon Larsen ◽

Thea Helene Degett ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Cox Regression ◽

Disease Stage ◽

Health Study ◽

Hospital Treatment ◽

Cancer Group ◽

Increased Risk ◽

Associated Risk Factors

We investigated the risk of depression in colorectal cancer (CRC) patients and associated risk factors. The 1324 patients with CRC and 6620 matched cancer-free participants from the Diet, Cancer and Health study were followed for up to 16 years for either a first hospitalization for depression or antidepressant prescription after diagnosis of CRC cancer or study entry date. Information on the outcome and covariates was retrieved from the Danish Colorectal Cancer Group database, the national health registries and questionnaires. Cumulative incidence of depression was estimated, and Cox regression models were used to evaluate the association between risk factors and depression incidence. During follow-up, 191 (14.4%) patients with CRC and 175 (2.6%) cancer-free comparison persons experienced depression. After adjustments, in the first year after cancer diagnosis, patients with CRC had a 12-fold higher hazard compared with the cancer-free population (HR, 12.01; 95% CI, 7.89–18.28). The risk decreased during follow-up but remained significantly elevated with an HR of 2.65 (95% CI, 1.61–4.36) after five years. Identified risk factors were presence of comorbidities, advanced disease stage and use of radiotherapy, while life style factors (pre-cancer or at diagnosis) and chemotherapy did not seem to contribute to the increased risk.

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Incidence and predictors of ophthalmic artery occlusion in intra-arterial chemotherapy for retinoblastoma

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016759 ◽

2020 ◽

pp. neurintsurg-2020-016759

Author(s):

Ahmad Sweid ◽

Kareem El Naamani ◽

Kalyan Chekravarthy Sajja ◽

Batoul Hammoud ◽

Michael D Knapp ◽

...

Keyword(s):

Ophthalmic Artery ◽

Chart Review ◽

Retrospective Chart Review ◽

Artery Occlusion ◽

Study Cohort ◽

Related Factors ◽

Artery Thrombosis ◽

Total Incidence ◽

Chemotherapy Infusion ◽

Intraocular Retinoblastoma

BackgroundRetinoblastoma is the most common primary intraocular malignancy in children.ObjectiveTo determine the incidence of ophthalmic artery (OA) occlusion in patients treated with selective ophthalmic artery catheterization (OAC) for chemotherapy infusion for retinoblastoma. Also, to evaluate technical, anatomical, tumorous, and patient-related factors that are predictors of OA occlusion.MethodsA retrospective chart review was performed for patients diagnosed with intraocular retinoblastoma and managed with intra-arterial chemotherapy (IAC).ResultsThe total study cohort included 208 retinoblastoma tumors of 208 eyes in 197 consecutive patients who underwent 688 attempted IAC infusions overall with a total of 624 successful OAC infusions. The total incidence of ophthalmic artery thrombosis was 11.1% (23/208). The numbers of successful OAC procedures before diagnosing OA occlusion were one OAC in six cases (27.3%), two in seven cases (31.8%), three in four cases (18.2%), four in one case (4.5%), five in two cases (9.1%), and six in one case (4.5%).ConclusionsLocal factors relating to the chemotherapy and selective microcatheterization of the OA are essential factors in the development of OA thrombosis, as seen by the association of OA thrombosis with the frequency of IAC.

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A Single Center Analysis over a Ten Year Period on Transplant Related Mortality (TRM), Early Relapse (ER) and Failure of Blood Cell Reconstitution (FBR) in High-Risk (HR) Cancer Patients (PTS) Undergoing Autologous PBSCT (auto-PBSCT): Frequency, Outcome and Prognostics.

Blood ◽

10.1182/blood.v104.11.5199.5199 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5199-5199

Author(s):

Monika Engelhardt ◽

Carsten Doeing ◽

Gabriele Ihorst ◽

Dagmar Wider ◽

Juergen Finke

Keyword(s):

Risk Factors ◽

Performance Status ◽

Early Death ◽

Median Number ◽

Disease Stage ◽

Safe Procedure ◽

Tumor Resistance ◽

Bulky Disease ◽

Platelet Counts

Abstract The outcome of hr cancer pts undergoing intensified chemotherapy (CTx) with risk factors, such as advanced disease, incomplete remission, tumor resistance and/or prior clinical complications can be dismal and remains a challenge. The prognostic factors for determining TRM, ER and FBR in hr cancer pts undergoing auto-PBSCT, allogeneic (allo)-PBSCT or intensified CTx have not yet been identified. Here, we analysed 50 cancer pts who died within three months of auto-PBSCT or had primary FBR, with a total of 796 pts undergoing auto-transplants over a 10 year period (6/93–5/2003) at our center. Median patient (pt) age at transplant was 52 years (y; range; 18–75), with underlying lymphoma, solid tumors or leukemias in 30, 14 and 6 pts, respectively. The disease stage in 90% (n=45) was advanced, bulky disease was present in 52%. Median performance status of all pts was 70%. An elevated LDH (median 365U/l) at diagnosis was present in 78% of pts. Treatment before auto-PBSCT consisted of a median number of 7 CTx cycles and radiation in 32% of pts. A median number of 4.1x10e6/kg bw PBSCs were transfused, with total CFUs (/1.5e5) of 128. Median platelet counts before PBSCT were 98x10e9/L, with persisting BM involvement in 38% and hypocellularity in 46% of pts. Transplant complications, leading to TRM, ER or FBR were observed in 18, 25 and 7 pts, respectively and resulted in early death in all pts, except one with CML and FBR, who was salvaged with back-up PBSCs. Thirteen pts were examined post-mortem and showed hypo- vs normocellular BM in 8 vs. 3 pts, respectively. Of note, FBR was observed in older pts (59 y), who were mostly heavily pretreated and had AML or CML (4 pts). They had been retransfused with lower CD34+ cells (2.9x10e6/kg), showed lower BFU-Es, CFU-GMs and GEMMs (30, 40, 3, respectively) and low platelet counts (27x10e9/L) before PBSCT due to active underlying disease (71%) and/or BM hypocellularity (71%). During post-transplant cytopenia all pts with FBR showed serious infections. These results suggest that the above risk factors are associated with TRM, ER and FBR. LDH and low platelet counts were significantly different between the three groups. In vitro culture data (cell expansion, CFU, LTC-IC) correlated with our clinical results. With a TRM of 2.26% and FBR in 0.88% in this hr pt cohort, auto-PBSCT is in general a very safe procedure. Nevertheless distinct risk factors can be determined and need to be considered before autotransplantation. Our results may also be valid for allo-SCT and intensified dose-dense chemotherapies.

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Abstract P145: Demographic And Clinical Predictors Of Incident Clinically-recognized Varicose Veins In Older Adults

Circulation ◽

10.1161/circ.143.suppl_1.p145 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Yejin Mok ◽

Shoshana Ballew ◽

Anna Kucharska-newton ◽

Kenneth R Butler ◽

Peter Henke ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cox Regression ◽

Troponin T ◽

Varicose Veins ◽

Adverse Outcomes ◽

Fee For Service ◽

Clinical Predictors ◽

White Race ◽

Female Sex

Background: Varicose veins are common in older adults, and associated with major clinical adverse outcomes such as deep venous thrombosis. Although there are a few established risk factors of varicose veins such as female sex, height, and obesity, some other risk factors demonstrated inconsistent results. Aim: To identify demographic and clinical risk factors of incident varicose veins Methods: Using data from the Atherosclerosis Risk in Communities (ARIC) Study over five clinic visits, we constructed a cohort of 6612 adults aged 65-70 years to be able to capture outpatient visits using Medicare data. For each participant, the first visit when meeting age range (65-70 years) was used as baseline. Varicose veins were defined as two outpatient encounters (at least a week apart) or inpatient diagnoses through 2015 (ICD9 codes:454.xx). Participants with clinically-recognized varicose veins prior to baseline were excluded. We explored demographic and clinical predictors routinely evaluated in ARIC visits using Cox regression. Results: During a median follow-up of 15 years, 348 (5%) of participants developed incident clinically-recognized varicose veins. We confirmed female sex, greater height, and higher body mass index were associated with varicose veins ( Table ). In addition, white race, loop diuretic use, prevalent heart failure were independently associated with incident varicosities. In subsample with relevant data, higher cardiac troponin T and natriuretic peptide were also independently associated with varicose veins. When we censored participants who left Medicare fee-for-service, results were largely consistent. Conclusions: In this community-based cohort study of older adults, in addition to established predictors, we found that white race and clinical and treatment factors related to cardiac function were associated with clinically-recognized varicose veins that may help identify those at high-risk of varicose veins.

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O6: EARLY ANASTOMOTIC BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION

British Journal of Surgery ◽

10.1093/bjs/znab117.006 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

SJ Tingle ◽

ER Thompson ◽

SS Ali ◽

IK Ibrahim ◽

E Irwin ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Hospital Stay ◽

Graft Survival ◽

Cox Regression ◽

Risk Groups ◽

Biliary Complications ◽

Anastomotic Strictures ◽

Selection Of Variables ◽

Independent Risk Factors

Abstract Introduction Biliary leaks and anastomotic strictures are common early biliary complications (EBC) following liver transplantation. However, their impact on outcomes remains controversial and poorly described. Method The NHS registry on adult liver transplantation between 2006 and 2017 was retrospectively reviewed (n=8304). Multiple imputations were performed to account for missing data. Adjusted regression models were used to assess predictors of EBC, and their impact on outcomes. 35 potential variables were included, and backwards stepwise selection enabled unbiased selection of variables for inclusion in final models. Result EBC occurred in 9.6% of patients. Adjusted cox regression revealed that EBCs have a significant and independent impact on graft survival (Leak HR=1.325; P=0.021, Stricture HR=1.514; P=0.002, Leak plus stricture HR=1.533; P=0.034) and patient survival (Leak HR=1.218; P=0.131, Stricture HR=1.578; P<0.001, Leak plus stricture HR=1.507; P=0.044). Patients with EBC had longer median hospital stay (23 versus 15 days; P<0.001) and increased chance for readmission within the first year (56% versus 32%; P<0.001). On adjusted logistic regression the following were identified as independent risk factors for development of EBC: donation following circulatory death (OR=1.280; P=0.009), accessory hepatic artery (OR=1.324; P=0.005), vascular anastomosis time in minutes (OR=1.005; P=0.032) and ethnicity ‘other’ (OR=1.838; P=0.011). Conclusion EBCs prolong hospital stay, increase readmission rates and are independent risk factors for diminished graft survival and increased mortality in liver transplantation. We have identified factors that increase the likelihood of EBC occurrence; further research into interventions to prevent EBCs in these at-risk groups is vital to improve liver transplantation outcomes. Take-home message Using a large registry database we have shown that early anastomotic biliary complications are independent risk factors for decreased graft survival and increased mortality after liver transplantation. Research into interventions to prevent biliary complications in high risk groups are essential to improve liver transplant outcomes.

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Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL)

RMD Open ◽

10.1136/rmdopen-2020-001299 ◽

2020 ◽

Vol 6 (3) ◽

pp. e001299

Author(s):

Cristina Reátegui-Sokolova ◽

Manuel F Ugarte-Gil ◽

Guillermina B Harvey ◽

Daniel Wojdyla ◽

Guillermo J Pons-Estel ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Latin American ◽

Lupus Erythematosus ◽

Renal Damage ◽

Cox Regression ◽

Damage Index ◽

Early Response ◽

Male Gender ◽

Systemic Lupus

AimA decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria.MethodsWe included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed.ResultsFive hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence.ConclusionsEarly response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.

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Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-045482 ◽

2021 ◽

Vol 11 (2) ◽

pp. e045482

Author(s):

Didier Collard ◽

Nick S Nurmohamed ◽

Yannick Kaiser ◽

Laurens F Reeskamp ◽

Tom Dormans ◽

...

Keyword(s):

Risk Factors ◽

Cox Regression ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Icu Admission ◽

Lowering Therapy ◽

Secondary Outcomes ◽

Age And Sex

ObjectivesRecent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes.DesignWe analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection.SettingPatients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included.ParticipantsAdmitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics.Primary and secondary outcomes measuresThe primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors.ResultsWe included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91).ConclusionsThe accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.

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A prospective sonographic evaluation of peripheral intravenous catheter associated thrombophlebitis

The Journal of Vascular Access ◽

10.1177/11297298211009019 ◽

2021 ◽

pp. 112972982110090

Author(s):

Nicholas Mielke ◽

Steven Johnson ◽

Patrick Karabon ◽

Amit Bahl

Keyword(s):

Risk Factors ◽

Cox Regression ◽

Assessment Tools ◽

Vein Wall ◽

True Incidence ◽

Related Risk ◽

Peripheral Intravenous Catheter ◽

Catheter Tip ◽

Catheter Size ◽

Observational Cohort

Objective: Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment. Methods: We conducted a single-site, prospective observational cohort study. Adult patients presenting to the emergency department that underwent traditionally placed PIVC insertion and were being hospitalized with an anticipated length of stay greater than 2 days were eligible participants. Using serial, daily ultrasound evaluations and clinical assessments via the phlebitis scale, we identified patients with asymptomatic and symptomatic thrombosis. The primary goal was to identify demographic, clinical, and IV related risk factors associated with thrombophlebitis. Univariate and multivariate analyses were employed to identify risk factors for thrombophlebitis. Results: A total of 62 PIVCs were included between July and August 2020. About 54 (87.10%) developed catheter-related thrombosis with 22 (40.74%) of the thrombosed catheters were characterized as symptomatic. Multivariate cox regression demonstrated that catheter diameter relative to vein diameter greater than one-third [AHR = 5.41 (1.91, 15.4) p = 0.0015] and angle of distal tip of catheter against vein wall ⩾5° [AHR = 4.39 (1.39, 13.8) p = 0.0116] were associated with increased likelihood of thrombophlebitis. Conclusions: Our study found that the increased proportion of catheter relative to vein size and steeper catheter tip angle increased the risk of thrombophlebitis. Catheter size relative to vein size is a modifiable factor that should be considered when inserting PIVCs. Additional larger prospective investigations using objective methodologies are needed to further characterize complications in PIVCs.

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Fermented pork fat (Sa-um) and lifestyle risk factors as potential indicators for type 2 diabetes among the Mizo population, Northeast India

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00257-8 ◽

2021 ◽

Vol 40 (1) ◽

Author(s):

Freda Lalrohlui ◽

Souvik Ghatak ◽

John Zohmingthanga ◽

Vanlal Hruaii ◽

Nachimuthu Senthil Kumar

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cox Regression ◽

Control Group ◽

Diabetic Patients ◽

Lifestyle Habits ◽

Pork Fat

AbstractOver the last few decades, Mizoram has shown an increase in cases of type 2 diabetes mellitus; however, no in-depth scientific records are available to understand the occurrence of the disease. In this study, 500 patients and 500 healthy controls were recruited to understand the possible influence of their dietary and lifestyle habits in relation with type 2 diabetes mellitus. A multivariate analysis using Cox regression was carried out to find the influence of dietary and lifestyle factors, and an unpaired t test was performed to find the difference in the levels of biochemical tests. Out of 500 diabetic patients, 261 (52.3%) were males and 239 (47.7%) were females, and among the control group, 238 (47.7%) were males and 262 (52.3%) were females. Fermented pork fat, Sa-um (odds ratio (OR) 18.98), was observed to be a potential risk factor along with tuibur (OR 0.1243) for both males and females. Creatinine level was found to be differentially regulated between the male and female diabetic patients. This is the first report of fermented pork fat and tobacco (in a water form) to be the risk factors for diabetes. The unique traditional foods like Sa-um and local lifestyle habits like tuibur of the Mizo population may trigger the risk for the prevalence of the disease, and this may serve as a model to study other populations with similar traditional practices.

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1147. Short Course of Voriconazole Therapy as a Risk Factor for Relapse of Invasive Pulmonary Aspergillosis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1333 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S600-S601

Author(s):

Dong Hoon Shin ◽

Seung-Jin Yoo ◽

Jongtak Jung ◽

Kang Il Jun ◽

Hyungjin Kim ◽

...

Keyword(s):

Risk Factors ◽

Cox Regression ◽

Tertiary Care ◽

Invasive Pulmonary Aspergillosis ◽

Care Hospital ◽

Pulmonary Aspergillosis ◽

Treatment Termination ◽

Duration Of Therapy ◽

Short Course ◽

Life Threatening

Abstract Background Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection which usually occurs in immunocompromised patients. Recommended duration of voriconazole therapy is a minimum of 6-12 weeks for IPA, despite the lack of any firm evidence. In addition, risk factors for relapse of IPA are still unclear. Here, we explored risk factors for IPA relapse after initial treatment. Methods All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography (CT). Results Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P=0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P=0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Conclusion Less improvement in CT, and short duration of voriconazole therapy were the independent risk factors for relapse after treatment of IPA. Longer duration of therapy should be considered for those at higher risk of relapse. Disclosures All Authors: No reported disclosures

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