A Systematic Review of Nutritional Lab Correlates with Chemotherapy Induced Peripheral Neuropathy

Chemotherapy induced peripheral neuropathy (CIPN) is a dose-limiting side effect of chemotherapy for which no prevention or cure exists. Cancer and cancer treatments can adversely affect nutritional status. Nutrition may play a role in development of CIPN, yet the relationship between nutrition and CIPN is not well understood. Common laboratory values measuring various aspects of nutrition (hemoglobin/hematocrit, vitamin B12, calcium, and magnesium) may be associated with CIPN. The aim of this systematic review is to evaluate the empirical evidence surrounding the relationship between laboratory measures of nutrition and CIPN among persons with cancer who received neurotoxic chemotherapy drugs. We conducted an extensive review of the literature to identify articles that evaluated relationships between laboratory measures of nutrition and CIPN. A total of eleven articles satisfied the inclusion/exclusion criteria. Participants in the studies had breast or colorectal cancer, lymphoma or multiple myeloma and were receiving a variety of neurotoxic drugs. Hemoglobin/hematocrit, vitamin D, albumin, and magnesium were associated with CIPN. The quality of the studies ranges from fair to good. Evidence suggests that low levels of the above-mentioned tests could be associated with CIPN but additional research is needed.

Herpes zoster in SLE: prevalence, incidence and risk factors

ObjectivesThis study aimed to evaluate the prevalence and incidence of herpes zoster (HZ) events and describe its associated factors in a study of patients with SLE.Methods491 consecutive SLE participants were screened for HZ events using a patient-reported questionnaire to capture outcomes on pain and other characteristics associated with HZ events. Sociodemographic, clinical and laboratory measures were also analysed, and time-dependent Cox regression survival analyses were performed to investigate factors associated with HZ events.ResultsPrevalence of HZ was 30.5%, incidence was 14.3 cases per 1000 person-years. Lymphopenia and glucocorticoid dosing were significantly associated with HZ events.ConclusionsHZ is highly prevalent in SLE, which may be linked to disease-related and treatment-related effects on cellular immunity. Our results suggest that the presence of certain risk factors may be useful to allow identification of patients at risk of HZ and improve its management in patients with SLE.

Iron Ladies: Variation in the Identification and Management of Iron Deficiency in Women with Bleeding Disorders

Background: Iron deficiency (ID) has negative clinical consequences on physical and cognitive abilities in adolescent and adult women. Women with heavy menstrual bleeding (HMB) are at particularly high risk for ID. Guidelines issued by the American College of Gynecology recommend obtaining a CBC and serum ferritin level to screen for ID in young women with HMB. Despite the high frequency of ID in women with HMB, there are no specific recommendations regarding screening in women with bleeding disorders (WBD), though 50% or more of this population may be affected by HMB. Information on the prevalence of ID and iron deficiency anemia in WBD is lacking. In addition, understanding of the optimal practice for iron supplementation has changed, with recent literature indicating less frequent supplementation improves iron absorption. We aimed to describe the screening practices for and management of ID in WBD through a survey of medical providers within hemophilia treatment centers (HTC). Methods: Electronic surveys were distributed by internet mail to medical providers who treat WBD within HTCs, based on membership rosters of the Hemostasis and Thrombosis Research Society and the American Thrombosis and Hemostasis Network. Data collected included indications for ID screening, laboratory measures for ID screening, iron supplementation in patients with ID (including route of administration, dose and dose frequency) and laboratory assessment to confirm iron repletion. Results: Responses were received from 62 medical providers. Providers reported seeing an average of 70 WBD/year (range 1-300), with ID identified in an average of 38 WBD/year (range 2-125). Screening for ID is completed in approximately 84.5% of WBD. Screening is a part of routine practice for 69.4% of providers, only 32.3% of respondents limit screening to women with HMB or other bleeding symptoms. Over 95% of providers utilize ferritin and hemoglobin to screen for ID. When ID is identified, oral supplementation is prescribed by 96.8% of those surveyed. The most used supplement is ferrous sulfate, with daily dosing employed by 54.8% of providers and alternate day dosing employed by 51.6% of providers. Oral iron dosing varies from 15mg to 325mg elemental iron per day (or 1-6mg/kg/day with weight-based dosing). Intravenous supplementation is prescribed by 80.6% of respondents. The most common indications include refractoriness to oral iron (75.8%) and non-compliance with oral iron (69.4%). The most recommended forms of IV iron are iron sucrose (43.5%) and ferric carboxymaltose (40.3%). Repeat labs are obtained to monitor iron repletion by 96.8% of providers, typically after three months of therapy, though the laboratory measures utilized vary widely. Discussion: All medical providers within HTCs report screening for ID in WBD, though not all WBD undergo screening. Notable variation is present in the formulation and dosing of iron supplementation used in patients with ID, as well as in follow-up practices. Given the prevalence of ID and its potential health burden, there is need for standardization of practices in screening of ID and iron replacement in WBD to promote early recognition and reduce the burden of disease in these women. This project was supported by funding through the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of HRSA H30MC2450 Figure 1 Figure 1. Disclosures Ragni: Alnylam (Sanofi): Membership on an entity's Board of Directors or advisory committees; University of Pittsburgh: Research Funding; BioMarin Pharmaceutical: Membership on an entity's Board of Directors or advisory committees; Bioverativ (Sanofi): Membership on an entity's Board of Directors or advisory committees; Spark Therapeutics: Membership on an entity's Board of Directors or advisory committees; Takeda Therapeutics: Membership on an entity's Board of Directors or advisory committees.

58 Relationship Between Early Laboratory Measures and Neurological Injury in Neonates Undergoing Therapeutic Hypothermia

Primary Subject area Neonatal-Perinatal Medicine Background Hypoxic-ischemic encephalopathy (HIE) is a major contributor to morbidity and mortality. Therapeutic hypothermia (TH) is the standard of care for neonates with moderate to severe HIE. Brain magnetic resonance imaging (MRI) is the imaging modality of choice for confirmation of HIE, assessment of injury severity, and prognostication. Reliable, inexpensive and widely available laboratory measures for early identification of risk for neurological injury can play a critical role in the optimal management of neonatal HIE, especially in the resource-limited setting. Our study examined whether derangements in early routine laboratory measures (acid-base, haematological, metabolic) were worse in neonates with MRI findings of neurological injury. Objectives Primary objective: To evaluate the role of early laboratory measures in predicting neurological injury as detected by MRI at 72 hours. Secondary objective: To evaluate the role of early laboratory measures in predicting survival to NICU discharge in patients with HIE. Design/Methods This single-centre, retrospective cohort study included neonates ≥ 35 weeks gestation with moderate to severe HIE, who had undergone therapeutic hypothermia. Based on findings of brain MRI completed within 72 hours of life, our cohort was divided into 2 groups: neonates with, and without, evidence of neurological injury consistent with HIE. Baseline characteristics, as well as laboratory measures, were compared between groups, and a receiver operating characteristic (ROC) curve analysis was conducted to determine the cut-off for prediction of neurological injury based on the highest sensitivity and specificity values. Results 104 neonates were analyzed. Baseline characteristics (Table 1) were similar between both groups, except for cord venous pH and base excess (BE), which were significantly lower in the abnormal MRI group (p = 0.02). In bivariate analysis, pH (at 1 h of age, p = 0.027), BE (at 1 h, p = 0.001, and 6 h of age, p = 0.004), ionized calcium (at 6 h of age, p = 0.02), and platelets (at 1 h of age, p = 0.004) were significantly different in neonates with abnormal MRI. In ROC curve analysis, BE at 1 h of life was the best predictor of abnormal MRI (AUC = 0.71, p = 0.002), with a cut-off value of ≤ -14.95, sensitivity of 67% and specificity of 66% (Figure 1). Conclusion Among neonates with HIE undergoing TH, early laboratory measures such as acid-base status, ionized calcium, and platelet count were worse in neonates with abnormal MRI, in comparison to neonates with normal MRI. Base excess at 1 h of life is a good predictor of abnormal MRI. Future prospective studies to validate these findings are needed

Individual cheating in the lab: a new measure and external validity

This paper investigates to what extent laboratory measures of cheating generalise to the field. To this purpose, we develop a lab measure that allows for individual-level observations of cheating whilst reducing the likelihood that participants feel observed. Decisions made in this laboratory task are then compared to individual choices taken in the field, where subjects can lie by misreporting their experimental earnings. We use two field variations that differ in the degree of anonymity of the field decision. According to our measure, no correlation of behaviour between the laboratory and the field is found. We then perform the same analysis using a lab measure that can only detect cheating at the aggregate level. In this case, we do find a weak correlation between the two environments. We discuss the significance and interpretation of these results.

A-136 The Transfer of Cognitive Training to Real-World Functioning: Results of our First Six Pilot Subjects at Six-Month Follow-Up

Objective Currently, the majority of cognitive training research measures treatment efficacy using in-laboratory measures, with minimal focus on real-world treatment changes. This case series demonstrates the feasibility of transferring cognitive improvements from the laboratory into the everyday life setting. Method This case series includes 6 chronic post-stroke participants; mild to moderate cognitive impairment. The intervention combines cognitive training with behavioral techniques, known as the Transfer Package (TP). The TP involves components that target functionality on IADLs in the real-world. Performance on cognitively-based IADLs in the real world are measured pre-treatment, post, and 6-month follow-up. Measures of real-world ability are the: Canadian Occupational Performance Measure (COPM), Cognitive Task Activity Log (CTAL) and Inventory of Improved and New Abilities (INCA). In-laboratory measures included the D-KEFS and Timed IADL assessments. Results The real-world outcome measures used in this study were the COPM and two measures developed for this study, the CTAL and INCA. The mean change from pre to post on the COPM Performance Scale was 2.18 (SD = 1.33) and the mean change on the COPM Satisfaction Scale was 2.70 (SD = 1.27). The mean change on the CTAL was 1.96 (SD = 0.93). On the INCA, the mean number of improved real-world cognitive activities was 11.8 (SD = 4.9) and the mean number of new cognitive activities was 7.6 (SD = 3.9). Follow-up reported near-perfect retention on CTAL and continued improvement on the INCA. There were minimal changes on in-laboratory measures. Conclusions This case series provides a framework for achieving the transfer of cognitive training treatment effects in the real-world life situation by overcoming behavioral barriers to functioning.

Maternal Attentional Control Moderates the Association Between Increased Depression and Controlling Feeding Practices During the COVID-19 Pandemic

Parental distress is associated with less healthful child feeding practices. In this preliminary study, we examined how changes in distress from before to during the COVID-19 pandemic were associated with similar changes in feeding practices in a sample of mothers of preschool-aged children. In addition, we examined how pre-pandemic laboratory measures of maternal self-regulation moderated this association. A total of 36 mothers from an ongoing study on parent and child self-regulation completed surveys assessing parental distress (i.e., maternal depression, parenting stress) and child feeding practices during pandemic-related stay-at-home orders in May–June 2020. These mothers had completed the same measures approximately 2 years earlier, along with laboratory assessments of inhibitory and attentional control. Pre-pandemic laboratory measures of attentional control significantly moderated the association between increased maternal depression and use of controlling feeding practices, such that mothers with better attentional, but not inhibitory, control scores did not show an effect of increased depression on feeding practices. These results provide preliminary evidence that acute increases in parental distress associated with “stay-at-home” orders affect feeding practices, specifically for mothers with lower levels of attentional control abilities.

Comparison of Laboratory and Daily-Life Gait Speed Assessment during ON and OFF States in Parkinson’s Disease

Accurate assessment of Parkinson’s disease (PD) ON and OFF states in the usual environment is essential for tailoring optimal treatments. Wearables facilitate measurements of gait in novel and unsupervised environments; however, differences between unsupervised and in-laboratory measures have been reported in PD. We aimed to investigate whether unsupervised gait speed discriminates medication states and which supervised tests most accurately represent home performance. In-lab gait speeds from different gait tasks were compared to home speeds of 27 PD patients at ON and OFF states using inertial sensors. Daily gait speed distribution was expressed in percentiles and walking bout (WB) length. Gait speeds differentiated ON and OFF states in the lab and the home. When comparing lab with home performance, ON assessments in the lab showed moderate-to-high correlations with faster gait speeds in unsupervised environment (r = 0.69; p < 0.001), associated with long WB. OFF gait assessments in the lab showed moderate correlation values with slow gait speeds during OFF state at home (r = 0.56; p = 0.004), associated with short WB. In-lab and daily assessments of gait speed with wearables capture additional integrative aspects of PD, reflecting different aspects of mobility. Unsupervised assessment using wearables adds complementary information to the clinical assessment of motor fluctuations in PD.

Specific characteristics of rapid diagnosis in periodontology

Currently, the advanced studies have been justified and implemented in the Republic of Belarus that enable the production and a practical use of a domestic rapid test and allow dentists to apply microbiological diagnosis methods.The objective of the study was to develop a domestic rapid test for periodontology, indicating the procedure for preparatory clinical and laboratory measures using PCR and trypsin-like activity of periopathogenic microflora (Treponema denticola, Porphyromonas gingivalis, Bacteroides forsythus)Dental examination was performed in 60 patients with clinical signs of generalized periodontitis and a 5‒6 mm deep pathological dentogingival pocket (PDGP), aged 35–44 (the main group), and 140 patients without signs of periodontal diseases, aged 20–24 (the control group). These patients were selected among the visitors of Chair No. 3 of the Belarusian State Medical University. The laboratory diagnosis was made using PCR and evaluating the trypsin-like activity of periopathogenic microflora.The algorithm of preparatory clinical and laboratory measures was suggested for diagnosis of periodontal diseases, including material sampling and identification of periopathogenic microorganisms in the sample using a biochemical method; sampling, preservation and storage of material for quantitative PRC testing; and the identification of the genetic material of periopathogenic microorganisms by means of a real-time quantitative PRC method.The basic principles of microbiological diagnosis in periodontology enable making a true diagnosis, planning treatment and assessing the treatment results.We examined the content of the gingival sulcus and/or the periodontal pocket in patients who have periodontal diseases. It was noted that the most rational tools for removing the periodontal pocket content in patients with periodontal diseases was a paper pin.The development of a domestic express test in periodontology demonstrated the need of preparatory clinical and laboratory activities using PCR and trypsin-like activity of periopathogenic microflora (Treponema denticola, Porphyromonas gingivalis, Bacteroides forsythus).