A COVID-19 pneumonia virtual follow-up service was established within Glasgow Greater and Clyde Health Board in line with national guidance. We aim to evaluate this service and identify patient factors which may predict likelihood of attendance. Using digital clinical systems, we retrospectively collected data on all patients referred to the service between March and August 2020. 802 patients were invited to attend our service. 82.7% of patients were discharged after virtual clinic review; 609 patients (75.9%) had radiological resolution and 54 patients (6.7%) failed to attend follow-up chest x-ray. Persistent radiological changes prompted a face to face (13 patients) or telephone (93 patients) clinic review, and patients could self-refer to the service if they had persistent symptoms. Subsequent investigations were organised for 150 patients inclusive of imaging, clinical physiology, blood tests and speciality referrals. Post-COVID19 diagnoses were made in 104 patients (12.9%) of the follow-up population including parenchymal lung disease, pulmonary thromboembolism and long COVID. We identified age, requirement for translator and number of household members as predictors for attending follow up. Patients were more likely to attend with increasing age (p <0.001) and with increased household numbers (p <0.001). The requirement of an interpreter significantly reduced the likelihood to attend (p=0.005). In conclusion, our follow-up service was effective in discharging patients with radiological resolution, identifying complications of COVID-19 and had low non-attendance rate. Developing the service to address language barriers and aid attendance for the elderly would be beneficial.

P157 Figure 1ConclusionsThe NHS GGC CRRT was able to safely and appropriately risk stratify patients and complement tertiary care by providing support at home with potential impact on reducing hospital admissions and deaths. Wider implementation of multidisciplinary community respiratory care could benefit patients and the healthcare service.

Aims: To reveal the prevalence of diabetes mellitus (DM) in patients with newly diagnosed rheumatoid arthritis (RA) and evaluate the association between clinical characteristics of RA and DM, as well as, treatment response in newly diagnosed RA patients with DM. Methods: Newly diagnosed, adult, RA patients, who were registered in Danish Danbio since 1st January 2010, were included. Patients' demographics, serology results including rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP) and antinuclear antibody (ANA), as well as, disease activity score in 28 joints-C-reactive protein (DAS28-CRP), at the time of diagnosis and after 4 months (+/- 1-2 months) of treatment initiation, were extracted from Danbio Regis try. To reveal the presence of DM, patients' electronic medical records were reviewed. The prevalence of DM in our patients was compared (using an age-and gender-matched analysis) with that expected from Danish population. Results: of 439 included patients, 60.1% were female, mean of age 64.6 +/- 15.0 years and RA disease duration 2.6 +/- 1.7 years. Prevalence of DM was 57/439 (12.9%), herein type II DM 52 (91.2%) and type I DM 5 (8.8%). Except for two patients, diagnosis of DM was established prior to the diagnosis of RA. The prevalence of DM in newly diagnosed RA patients of all ages was significantly increased versus that expected from Danish population (RR=2.21, CI=1.40-3.42, P <0.001). In addition, prevalence of DM was significantly increased with more than twice of the expected for RA patients aged 65-84. Both genders showed increased risk of DM after subgroup analysis. The presence of DM in RA patients was significantly associated with age (P <0.001) and RA disease duration >= 4 years (P =0.05). We did not find any significant associations between presence of DM and gender, RF, anti-CCP, as well as, ANA. Additionally, presence of DM in the RA patients was not a negative predictor of treatment response measured by the European League Against Rheumatism (EULAR) response criteria and DDAS28-CRP. Conclusion: Newly diagnosed RA patients are at higher risk of DM (13% versus 5.7% in Denmark), and a high index of suspicion must be kept.

Purpose/Objective(s)Stereotactic body radiation therapy (SBRT) has been shown to be safe and effective in the treatment of early stage lung cancers. After prior lung surgery, surgical resection is the preferred treatment for recurrent or second primary lung cancers in the operable candidate. In non-operable patients, conventional RT, SBRT, and radiofrequency ablation are treatment options. We analyzed the outcomes of patients treated with SBRT after previous lung surgery to assess the safety and efficacy of SBRT after lung resection.Materials/MethodsIn this IRB-approved retrospective study, we reviewed 45 patients treated with SBRT to 59 non-small cell lung carcinoma (NSCLC) lesions after prior definitive wedge resection, lobectomy, or pneumonectomy. All patients were treated with SBRT after CT simulation with full body immobilization. SBRT doses ranged from 25 - 48 Gy (median 48 Gy) and were delivered in 3- 5 fractions, using IGRT with each fraction. Patient characteristics and outcomes were analyzed.ResultsMedian age was 70.9 (48 - 87) and 75.5 years (54 - 97) at surgery and SBRT, respectively. Twenty (44%) patients underwent wedge resection, 24 (53%) lobectomy, and 1 (2%) pneumonectomy. Thirteen (29%) patients had previous lung surgery. T stage was T1 in 26 (58%), T2 in 16 (36%), T3 in 1 (2%), and unknown in 2 (4%) patients. One (2%) patient was N2, while 3 (7%) were N1, 25 (56%) were N0, and 16 (36%) were unknown. Nine (20%) patients received adjuvant chemotherapy and 6 (13%) adjuvant radiation after surgery. Pathology was squamous cell in 11 (24%), adenocarcinoma in 30 (67%), poorly differentiated NSCLC in 2 (4%), large cell in 1 (2%) and unknown in 1 (2%) patients. At a median of 3.6 years (0.1 - 17) after surgery, SBRT was delivered to the same lobe as prior surgery in 14 (24%), ipsilateral lung in 24 (41%), contralateral lung in 16 (27%), and mediastinum in 5 (8%) lesions. There were other sites of disease outside of the SBRT target with 18 (31%) lesions. Failure occurred after SBRT in twenty-nine (49%) lesions. The most common site of failure was distant with a component in 25 (42%) of treated lesions while 8 (14%) had local failure and 11 (19%) had regional failure. Local failure alone occurred after treatment to 2 (3%) lesions. Of the patients that failed, 10 (35%) received salvage chemotherapy and 14 (48%) received further radiation therapy. At a median follow-up of 1.3 years (0.1 - 8.0), 24 (53%) patients were alive without evidence of active disease, 9 (20%) living with disease, and 12 (27%) dead with 8 dying from lung cancer. No patient experienced grade 3 or higher toxicity.ConclusionsSBRT appears to be a safe, feasible and effective treatment after prior lung surgery, however, with the high rate of distant failure more research into systemic treatments may benefit these patients. Purpose/Objective(s)Stereotactic body radiation therapy (SBRT) has been shown to be safe and effective in the treatment of early stage lung cancers. After prior lung surgery, surgical resection is the preferred treatment for recurrent or second primary lung cancers in the operable candidate. In non-operable patients, conventional RT, SBRT, and radiofrequency ablation are treatment options. We analyzed the outcomes of patients treated with SBRT after previous lung surgery to assess the safety and efficacy of SBRT after lung resection. Stereotactic body radiation therapy (SBRT) has been shown to be safe and effective in the treatment of early stage lung cancers. After prior lung surgery, surgical resection is the preferred treatment for recurrent or second primary lung cancers in the operable candidate. In non-operable patients, conventional RT, SBRT, and radiofrequency ablation are treatment options. We analyzed the outcomes of patients treated with SBRT after previous lung surgery to assess the safety and efficacy of SBRT after lung resection. Materials/MethodsIn this IRB-approved retrospective study, we reviewed 45 patients treated with SBRT to 59 non-small cell lung carcinoma (NSCLC) lesions after prior definitive wedge resection, lobectomy, or pneumonectomy. All patients were treated with SBRT after CT simulation with full body immobilization. SBRT doses ranged from 25 - 48 Gy (median 48 Gy) and were delivered in 3- 5 fractions, using IGRT with each fraction. Patient characteristics and outcomes were analyzed. In this IRB-approved retrospective study, we reviewed 45 patients treated with SBRT to 59 non-small cell lung carcinoma (NSCLC) lesions after prior definitive wedge resection, lobectomy, or pneumonectomy. All patients were treated with SBRT after CT simulation with full body immobilization. SBRT doses ranged from 25 - 48 Gy (median 48 Gy) and were delivered in 3- 5 fractions, using IGRT with each fraction. Patient characteristics and outcomes were analyzed. ResultsMedian age was 70.9 (48 - 87) and 75.5 years (54 - 97) at surgery and SBRT, respectively. Twenty (44%) patients underwent wedge resection, 24 (53%) lobectomy, and 1 (2%) pneumonectomy. Thirteen (29%) patients had previous lung surgery. T stage was T1 in 26 (58%), T2 in 16 (36%), T3 in 1 (2%), and unknown in 2 (4%) patients. One (2%) patient was N2, while 3 (7%) were N1, 25 (56%) were N0, and 16 (36%) were unknown. Nine (20%) patients received adjuvant chemotherapy and 6 (13%) adjuvant radiation after surgery. Pathology was squamous cell in 11 (24%), adenocarcinoma in 30 (67%), poorly differentiated NSCLC in 2 (4%), large cell in 1 (2%) and unknown in 1 (2%) patients. At a median of 3.6 years (0.1 - 17) after surgery, SBRT was delivered to the same lobe as prior surgery in 14 (24%), ipsilateral lung in 24 (41%), contralateral lung in 16 (27%), and mediastinum in 5 (8%) lesions. There were other sites of disease outside of the SBRT target with 18 (31%) lesions. Failure occurred after SBRT in twenty-nine (49%) lesions. The most common site of failure was distant with a component in 25 (42%) of treated lesions while 8 (14%) had local failure and 11 (19%) had regional failure. Local failure alone occurred after treatment to 2 (3%) lesions. Of the patients that failed, 10 (35%) received salvage chemotherapy and 14 (48%) received further radiation therapy. At a median follow-up of 1.3 years (0.1 - 8.0), 24 (53%) patients were alive without evidence of active disease, 9 (20%) living with disease, and 12 (27%) dead with 8 dying from lung cancer. No patient experienced grade 3 or higher toxicity. Median age was 70.9 (48 - 87) and 75.5 years (54 - 97) at surgery and SBRT, respectively. Twenty (44%) patients underwent wedge resection, 24 (53%) lobectomy, and 1 (2%) pneumonectomy. Thirteen (29%) patients had previous lung surgery. T stage was T1 in 26 (58%), T2 in 16 (36%), T3 in 1 (2%), and unknown in 2 (4%) patients. One (2%) patient was N2, while 3 (7%) were N1, 25 (56%) were N0, and 16 (36%) were unknown. Nine (20%) patients received adjuvant chemotherapy and 6 (13%) adjuvant radiation after surgery. Pathology was squamous cell in 11 (24%), adenocarcinoma in 30 (67%), poorly differentiated NSCLC in 2 (4%), large cell in 1 (2%) and unknown in 1 (2%) patients. At a median of 3.6 years (0.1 - 17) after surgery, SBRT was delivered to the same lobe as prior surgery in 14 (24%), ipsilateral lung in 24 (41%), contralateral lung in 16 (27%), and mediastinum in 5 (8%) lesions. There were other sites of disease outside of the SBRT target with 18 (31%) lesions. Failure occurred after SBRT in twenty-nine (49%) lesions. The most common site of failure was distant with a component in 25 (42%) of treated lesions while 8 (14%) had local failure and 11 (19%) had regional failure. Local failure alone occurred after treatment to 2 (3%) lesions. Of the patients that failed, 10 (35%) received salvage chemotherapy and 14 (48%) received further radiation therapy. At a median follow-up of 1.3 years (0.1 - 8.0), 24 (53%) patients were alive without evidence of active disease, 9 (20%) living with disease, and 12 (27%) dead with 8 dying from lung cancer. No patient experienced grade 3 or higher toxicity. ConclusionsSBRT appears to be a safe, feasible and effective treatment after prior lung surgery, however, with the high rate of distant failure more research into systemic treatments may benefit these patients. SBRT appears to be a safe, feasible and effective treatment after prior lung surgery, however, with the high rate of distant failure more research into systemic treatments may benefit these patients.

BACKGROUND:There is considerable variation in adolescent pain prevalence across epidemiological studies, with limited information on pain-related behaviours among adolescents, including medicine use. The aims of this study were (1) to examine the prevalence of recurrent pain among 15-year-old adolescents internationally; (2) to investigate the association between recurrent pain and medicine use behaviours among boys and girls; and (3) to evaluate the consistency of these associations across countries.METHODS:The World Health Organization (WHO) collaborative international Health Behaviour in School-aged Children 2009/2010 study collects data about self-reported aches and medicine use from 36,762 15-year-old adolescents from 22 countries/regions in Europe and the United States. Multi-level multivariate logistic regression, stratified by gender, was used to analyse the association between recurrent pain and medicine use for headache, stomachache, nervousness and difficulties in getting to sleep.RESULTS:More than 30% of adolescents reported recurrent headache, almost 30% recurrent backache and approximately 20% recurrent stomachache. Although pain prevalence and medicine use for aches were much higher for girls, the association between pain and medicine use was similarly strong for both genders. Adolescents with recurrent pain are more likely to use medicines also for non-corresponding pain, nervousness and difficulties in getting to sleep. The association between recurrent pain and medicine use was consistent across countries despite large-country differences in the prevalence of recurrent pain and medicine use.CONCLUSIONS:Recurrent pain in adolescence is common cross-nationally. Adolescents with recurrent pain are more likely to use medicine in general. Recurrent pain and medicine use should be addressed in adolescent health policies.

Fragestellung: Many studies show negative impact of inflammation-mediating molecules like Tumor necrose factor α (TNFα) or Interleukin-6 (IL6) on insulin signaling in skeletal muscle (Plomgaard et al. 2005, Guilherme et al. 2008). Conversely, only few studies have investigated the effect of insulin on generation of these cytokines (Krogh-Madsen et al. 2003, Plomgaard et al. 2007). Here we hypothesize that increased abundance of the transcription factor FoxO4 may play a role in cytokine-mediated perturbation of insulin signaling.

AIMS/HYPOTHESIS:The pathophysiological role of gut incretin hormone argumentation on acute insulin release in the genesis of type 2 diabetes (TDM2) is uncertain. We examined retrospectively at 0 year and 10 years the endogenous incretin hormone action (IHA) on acute insulin release and glucose tolerance in normoglycemic relatives (REL) of TDM2 and control (CON) subjects.METHODS:At 0 year and 10 years, glucose tolerance, paired oral glucose tolerance test (OGTT)- and i.v. glucose tolerance test (IVGTT)-induced acute (0-30 min) insulin release (insulinogenic index IGIOGTT and IGIIVGTT), and IHA were calculated in 19 REL and 18 CON subjects by cross-correlation linear regression slope analyses of the OGTT (0-30 min) matched insulin/glucose profiles vs the early (0-5 min) and delayed (10-30 min) IVGTT profiles.RESULTS:At 0 year, REL and CON IGIOGTT and IGIIVGTT were similar, but the REL 2- to 5-min IVGTT-induced insulin responses were reduced (P < .03). By 10 years, glucose tolerance deteriorated in nine dysglycemic REL (RELDGT), with raised fasting glucose and 2-hour OGTT glucose. Retrospective analyses of RELDGT at 0 year demonstrated raised proinsulin/insulin molar ratios and fasting glucose and a reduced IVGTT insulin/glucose slope, but the RELDGT IHA was similar to normoglycemic REL (RELNGT) and CON. By 10 years, RELDGT OGTT insulin/glucose slopes were reduced (P = .03-.01), but more so for the early (P < .01-.003) and delayed (P < .005-.002) IVGTT slopes, compared to the normoglycaemic REL and CON subjects.CONCLUSIONS:IHA on acute insulin release is maintained in normoglycemic REL and CON subjects over 10 years. The apparent deterioration in IHA in RELDGT is consistent with a progressive failure of acute β-cell function over 10 years.

AIMS:Reduced glucose effectiveness is a predictor of future glucose tolerance in individuals with a family history of type 2 diabetes. We examined retrospectively at 10 years in normoglycemic relatives of diabetic subjects (RELs) the pathophysiological role of glucose effectiveness in the development of isolated impaired fasting glucose, glucose intolerance, and acute insulin release.METHODS:At 0 years, 19 RELs and 18 matched control subjects had glucose effectiveness (GE), insulin sensitivity, acute insulin release (AIR)IVGTT, and disposition index measured during an iv glucose tolerance test (IVGTT), using the minimal model analysis. At 0 and 10 years, oral glucose tolerance (OGTT) and AIROGTT were determined.RESULTS:At 0 years, fasting glucose (FG) and GE were raised in RELs, but insulin sensitivity and AIROGTT were reduced (P ≤ .05) compared with controls. At 10 years, RELs developed raised fasting and 2-hour OGTT glucose. FG10y correlated significantly with FG0y and body mass index0y and negatively with √GE and 2-hour OGTT glucose10y with FG0y and negatively with AIRIVGTT0y and AIROGTT0y. Log AIROGTT10y correlated with √GE, log AIRIVGTT0y and log AIROGTT0y. Multiple regression analyses demonstrated the following: REL FG10y was predicted by combined FG0y, √GE and body mass index0y (radj(2) = 56%; P ≤ .001) and 2-hour OGTT glucose10y weakly related by FG0y,and √GE (r(adj)(2) = 25%; P = .06). Log AIROGTT10y was predicted by AIRIVGTT0y and √GE (r(adj)(2) = 46%; P ≤ .004).CONCLUSION:In normoglycemic RELs, a relative reduction of glucose effectiveness is an important contributor over 10 years to the development of isolated impaired fasting glucose and reduced acute insulin secretion.

Introduction: It is controversial whether alterations in initial insulin signaling (IS) steps contribute in skeletal muscle (SkM) to insulin resistance in obesity and/or type 2-diabetes. Here we investigated insulin-stimulated Akt, and AS160 phosphorylation. Abundance of the transcription factor FoxO4 was studied since we hypothesized that FoxO4 may play a role in cytokine-mediated perturbation of IS.

To describe our clinical implementation of a Radiation Oncology dedicated, open high-field 1.0T MR-SIM, with the overarching goal of using MR-SIM for single modality simulation. Magnetic field homogeneity was quantified (volume root mean square) in three planes for a 31 cm diameter phantom via phase difference analysis of 2D gradient echo sequences (TE1/TE2/TR/α = 10/12/500ms/20º). Two-dimensional and 3D system-level distortions were characterized for large field of view (FOV) phantoms using template-based analysis for the former, and deformable image registration to CT-SIM for the latter. MR-SIM was conducted as an adjunct to CT-SIM for > 70 patients undergoing brain, prostate, spine, and abdomen RT. Workflow was optimized including MR-compatible immobilization, rigid coils, flat tabletop, and implementation of bridged lasers. Healthy volunteers and patients were consented to an IRB-approved protocol to optimize parameters for (1) bony segmentation via 3D ultrashort echo time-DIXON (UTE-DIXON, free-induction decay and 2 DIXON echoes, TE1/TE2/TE3/TR/α = 0.14/2.4/4.7/8.1 ms/25º, voxel size ≈1.6-2 mm3) and (2) motion management using respiratory-triggered, T2-weighted single-shot Turbo Spin Echo 4D-MRI (6-10 phases, TE/TR/α = 30-96/4500-6100 ms/90◦, voxel size ≈1 × 1 × 5-10 mm3). Synthetic CTs (SynCTs) were generated via voxel-based weighted summation of MR-SIM data combined with semi-automatic bony segmentation. Dose calculation was performed on SynCTs with fixed monitor units. Gamma analysis at isocenter quantified planar dose differences from CT-SIM. Magnetic field inhomogeneity was < 1 ppm. Two-dimensional in-plane distortion was < 2 mm within ∼28-33 cm of isocenter and stable over 8 months. Within 5-10 cm radius of isocenter, mean 3D, B0 field distortion was 0.9 ± 0.5 mm, maximum = 3.1 mm, although distortion magnitude increased farther from isocenter (15-20 cm: 2.4 ± 1.4 mm, maximum = 7.3 mm). Immobilization devices and patient positioning were reproduced between MR and CT-SIM. UTE-DIXON provided contrast between bone and air for brain RT; efforts are needed to refine UTE for large FOVs Abdominal 4D-MRI yielded adequate image quality, with duty cycles of 26-51% for 10 phase irregular and regular breathing, respectively, and examination times of 6-13 mins. Differences in CT number between SynCT and CT-SIM were negligible for soft tissue (-0.8 ± 13.3 HU [< 1%]) and slightly higher for bony anatomy (-56.3 ± 33.3 HU [∼4%]). Gamma analysis between dose calculations at 2%/2 mm and 1%/1 mm were 99.9 ± 0.1% and 97.2 ± 2.5%, respectively, suggesting that SynCT generated accurate dosimetric results. MR-SIM has been integrated into our RT workflow. To fully implement MR-only simulation, further efforts are needed to correct SynCT images for system-level distortions and quantify object-induced distortions.

The adrenal gland is a common site of metastasis in lung and other cancers. Surgical resection, radiofrequency ablation and chemoembolization are used to treat these metastases. Stereotactic body radiation therapy (SBRT) is being investigated as a non-invasive alternative for the treatment of these lesions. We present our experience of using SBRT for the treatment of adrenal metastases. We conducted an IRB approved, retrospective review of patients with adrenal metastases treated with SBRT. Treatment details were reviewed and tumor response was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) at time of first post-SBRT CT scan and also for any subsequent CT scans obtained at follow-up. Best tumor response was defined as the greatest percent tumor reduction or least amount of disease progression noted on any post-SBRT CT. Twenty-five patients were identified with 30 metastatic adrenal lesions treated with SBRT between the years 2001 and 2012; median age at treatment was 60.4 years (range, 25.8-85 years). Primary diagnoses include NSCLC (15 patients, 19 lesions), small cell lung cancer (1 patient), hepatocellular carcinoma (3 patients) and other (6 patients). Five patients had solitary adrenal metastases at time of SBRT. Twelve lesions received a single fraction - median dose 18 Gy (range, 14-18 Gy). Eighteen lesions were treated with multiple fractions with median dose of 32 Gy (range, 16-40 Gy) and median dose/fraction of 7 Gy (range, 3-8 Gy). The median GTV was 70.97 cc (range, 0.69 - 984.54 cc) and median PTV was 72.8 cc (range, 3.21-984.54 cc). Median follow-up for first post-SBRT CT (n = 22 lesions) was 1.6 months (range, 0.87-5.37 months) and for CT showing best tumor response post-SBRT (n = 14 lesions) was 4.7 months (range, 0.9-44.8 months). Tumor response is presented in the Table. No grade 3 or 4 acute toxicities were noted; 1 patient experienced duodenal perforation due to ulcer 14 months after treatment with 18 Gy in 1 fraction. At time of analysis 16 patients are deceased with median survival after SBRT of 4.8 months (range, 0.4-26.5 months); 5 patients are alive with median survival after SBRT of 33.1 months (range, 2-42.3 months). One patient with NSCLC was treated to the left adrenal lesion thrice in 4 years; he is living 42 months after first course of SBRT. Our results suggest that SBRT for treatment of adrenal metastases is feasible and efficacious in demonstrating tumor control. Further study of impact on survival and quality of life is warranted.Poster Viewing Abstract 2369; TableTumor responseAll lesionsNSCLC lesionsSingle fraction SBRT lesionsMultiple fraction SBRT lesionMedian percent tumor response at first post-SBRT CT (%)7.6 (−34.5-100)8.7 (−34.5-100)8.7 (−26.3-23)7.7 (−34.5-100)Complete or partial response (CR or PR)2 (1 CR, 1 PR) (9%)2 (1 CR, 1 PR) (13%)02 (1 CR, 1 PR) (13.3%)Stable disease (SD)17 (77%)12 (80%)6 (86%)11 (73.3%)Progressive disease (PD)3 (14%)1 (7%)1 (14%)2 (13.3%)-----Median best tumor response (%)27.6 (−34.5-100)20.3 (−34.5-100)30.9 (−11.7-100)27.6 (−34.5-100)CR or PR6 (2 CR, 4 PR) (43%)4 (2 CR, 2 PR) (40%)2 (1 CR, 1 PR) (50%)4 (1 CR, 3 PR) (40%)SD7 (50%)5 (50%)2 (50%)5 (50%)PD1 (7%)1 (10%)01 (10%) Open table in a new tab

Congenital nephrogenic diabetes insipidus (NDI) is a rare X-linked recessive disorder associated with germline mutations of the arginine vasopressin (AVP) receptor type 2 (AVPR2) gene. The researchers describe a novel mutation in the AVPR2 gene in a three-generational Turkish family with NDI. In the present report, a 22-year-old man is reported with polyuria and bilateral non-obstructive hydronephrosis. He was diagnosed with partial NDI based on the clinical phenotype, the water deprivation test and the inadequate response to 1-desamino-8-Darginine vasopressin (DDAVP) administration. All family members who were suspected to have diabetes insipidus and/or related symptoms were studied. Sequencing analysis of the AVPR2 gene revealed the novel missense mutation c.392 T>C; p. Leu 131 Pro:L131P (AVPR2 gene (coding seq # NM_000054.4;prot seq # NP_000045.1). In conclusion, the proband carries a novel AVPR2 missense mutation inherited from his carrier mother.

Background: The increasing number of patients with diabetes poses a major challenge for the health care system. One instrument to meet these challenges could be the use of telemedicine, which, at the same time, may reduce treatment costs. Since 2005, diabetes patients on the island of Aeroe have been offered expert diabetes care using teleconsultations. This article describes the impact of the telemedicine solution on essential diabetes treatment parameters, patient satisfaction, and cost-effectiveness. Methods: Telemedicine consultations were conducted with the patient and nurse specialist placed in a consultation room of Aeroe Hospital in audiovisual contact with the physician situated at the hospital on the mainland. Consultations were supported by an electronic patient record and a Web-based quality-monitoring diabetes database. Results: Inclusion criteria in this retrospective study were at least 6 months of telemedicine diabetes control with a minimum of two visits and two hemoglobin A1c (HbA1c) values. Results were compared with data from the Danish National Diabetes Registry (DVDD). Data are given in medians. In total, 23 type 1 diabetes mellitus (T1DM) patients, aged 65 (56–74) versus 48 years, diabetes duration 21.0 (10.7–31.3) versus 20.5 years, and 55 type 2 diabetes mellitus (T2DM) patients, aged 67 (64–70) versus 65 years, diabetes duration 14.0 (10.5–17.5) versus 11.7 years, were included. After teleconsultation, HbA1c in T1DM patients was 8.0% (7.4–8.6%) versus 7.9% [64 (57–71) versus 63 mmol/mol], not significant, and in T2DM patients was 7.4% (7.1–7.7%) versus 7.6% [57 (54–61) versus 60 mmol/mol], p < .05. Body mass index, blood pressure, and lipid values were comparable with the DVDD. Patient satisfaction was especially related to the major reduction in transportation time (7 h). Reductions in traveling costs and saved working days were the most important factors in making the telemedicine set-up economically efficient. Conclusion: Telemedicine consultation for remote outpatient diabetes control is feasible, and the interdisciplinary interventions achieved high treatment quality results in essential diabetes treatment parameters. In addition, the telemedicine set-up was associated with improved cost-effectiveness and patient satisfaction.

BACKGROUND:This study aimed to compare the metabolic and insulin secretory responses to dexamethasone with the metabolic responses observed at 10 years in normoglycaemic relatives of type 2 diabetic and healthy control subjects.METHODS:Twenty relatives and 20 matched control subjects were studied twice at 0 year (pre- and post-dexamethasone) and at 10 years, employing a 75-g oral glucose tolerance test (OGTT), with serial measurements of glucose and insulin, for determination of glucose tolerance and calculations of acute insulin release (ΔI30 /ΔG30 ; insulinogenic index) and insulin sensitivity (SIHOMA ).RESULTS:Following dexamethasone, the relatives group developed varying degrees of glucose intolerance, associated with reduced insulin sensitivity and insulinogenic index. By 10 years, fasting glucose and 2-h OGTT glucose were raised in the relatives group, especially in the relatives most metabolically affected by dexamethasone, including a reduced insulinogenic index. Multiple regression analysis of the data in relatives demonstrated that the 2-h OGTT glucose and fasting glucose values at 10 years depended on the 0-year post-dexamethasone 2-h OGTT glucose, post-dexamethasone fasting glucose and post-dexamethasone insulin sensitivity, r(2) adj = 56% (p < 0.001) and r(2) adj = 60% (p < 0.0001), respectively. No pre-dexamethasone metabolic or insulin secretory responses entered these models.CONCLUSIONS:In relatives, fasting and 2-h OGTT glucose concentrations and β-cell responses to acute dexamethasone-induced insulin resistance are similar to those observed at 10 years, especially in relatives who develop the most disturbed dexamethasone-induced glucose intolerance and impaired acute insulin secretion. The combined 0-year, post-dexamethasone fasting and 2-h OGTT glucose concentrations and insulin resistance, measured as SIHOMA , are the best predictors in relatives of future dysglycaemia.

PURPOSE:We hypothesize that PTV margin dose is an important factor for local tumor control. We evaluated dose distributions for patients originally treated with pencil-beam (PB)-based plans and retrospectively calculated with Monte Carlo (MC) method, with emphasis on the spatial region between the ITV and PTV (PTV-margin), where the largest dose differences were expected. METHODS:Forty-six stage I-II lung cancer patients with 51 lesions treated with SABR were retrospectively analyzed (23 central and 28 peripheral tumors). All patients received 4DCT imaging, and an ITV was generated from the maximum intensity projection and subsequent review of four 4DCT phases. An isotropic 3mm ITV-to-PTV margin was used. The iPlan TPS was used to generate the original treatment plans using PB-based heterogeneity correction. MC doses were recalculated using the same MUs as in the PB plan. Dose distributions for the ITV, PTV-margin, and PTV were analyzed using generalized equivalent uniform dose (gEUD) with a = - 20. Student's paired t-test elucidated differences between PB and MC-based gEUD and the two different tumor locations. RESULTS:Mean ITV and PTV volumes were 24.2 cc (range: 2.2 to 99.3 cc) and 50.4 cc (range: 6.4 to 229.7 cc), respectively. The mean gEUDs of ITV, PTV-margin and PTV, normalized to PB-based 100% isodose were 1.02+/-0.04, 1.01+/-0.04 and 1.01+/-0.04 for PB-based plans, compared to 0.94+/-0.06, 0.88+/-0.08 and 0.90+/-0.08 (all p<0.05) for MC-based plans. The maximum overestimations with the PB algorithm in the PTV-margin average dose were 10.4% and 19.6% (p < 0.05) for peripheral tumor cases and central tumor cases, respectively. CONCLUSIONS:PB-based dose distributions showed the highest dose overestimation (relative to MC) in the PTV-margin spatial region. Analysis of spatial dose differences is an important precursor toward assessment of patterns-of-local failure, to be investigated in future work to explore possible association between dose and regions of failure. Acknowledgement: supported in part by grants from NIH R01 CA106770 and from Varian Medical Systems.

Purpose: It is essential for radiation oncology departments to have comprehensive patient safety and quality programs. Two years ago we undertook a systematic review of our safety/QA program. Existing policies were updated and new policies created where necessary. One crucial component of any safety/QA program is continually updating it based on current information, the ‘check’ and ‘act’ portions of the Deming Cycle. We accomplished this with a transparent variance reporting system and a safety/QA committee reviewing and acting on reported variances. Methods: With 5 radiation oncology centers in our institution, we needed to devise a system that would allow anyone to report a variance and provide our QA committee the ability to review variances system‐wide. We developed the system using web‐based tools. The system allows individuals to report variances, anonymously or named, specify the nature of the variance and indicate the tools used to identify the variance. Results: In 2011, 285 variances were reported, 102 were reported by physicists, 86 anonymously, 71 by therapists and 26 by dosimetrists. We realized the need to develop clear classifications for variances. We added a high priority category, defined as variances which resulted in or had the potential to result in harm to a patient or when a policy is purposely overridden. Of the 285 variances reported, 5 were high priority. We created a process variance category, defined as variances where a specific clinical process is not followed. Of the 285 reported variances 155 were process variances. Conclusions: Reporting of variances through a centralized database is central toward developing a robust patient safety/quality assurance program. Anonymous reporting fosters a non‐punitive environment, and promotes the ‘safety culture’. The goal of such a system is to review trends in clinical processes and ultimately to improve safety/quality by reducing variances associated with these processes.

The molecular mechanisms underlying insulin resistance in skeletal muscle are incompletely understood. Here, we aimed to obtain a global picture of changes in protein abundance in skeletal muscle in obesity and type 2 diabetes, and those associated with whole-body measures of insulin action.

PURPOSE:To compare localization accuracies between an ExacTrac and cone beam computed tomography (CBCT) systems for single fraction spine adiosurgery. The work also aimed to evaluate the inherent systematic deviation of both ExacTrac and CBCT systems to achieve highly accurate localization in the spine radiosurgery. METHODS:ExacTrac and CBCT imaging systems were evaluated using the linac isocenter as the mutual reference point. First, a BB was placed in an anthropomorphic pelvic phantom. The phantom was localized with both imaging systems and the procedure was repeated 12 times. These results were used to devise a localization protocol using both imaging systems in spine radiosurgery, and employed for 51 patients (81 isocenters) prescribed for single fraction treatment. The displacement discrepancy between the isocenter and two systems were quantified in four dimensions (three translations, one rotation). A Student's two-tailed t-test was used to test for significant differences between the two imaging systems. RESULTS:The phantom study showed 1.4±0.5, 0.6±0.5, and 0.1±0.5 mm differences between the two imaging systems in the anterior/posterior (A/P), superior/inferior (S/I) and left/right (L/R) directions, respectively. The angular difference was minimal along all three axes. The patient study revealed similar isocenter discrepancies between ExacTrac and CBCT of 1.1 ± 0.7 mm, 1.0±0.9 mm, and 0.2±0.9 mm in the A/P, S/I, and L/R directions, respectively, with the A/P and S/I directions showing statistical significance ((t(80) = 13.5 and 7.6 respectively, p = 0.000). The couch yaw discrepancy was 0 ± 0.3°. Overall, 1 mm systematic differences were observed in the A/P and S/I directions between ExacTrac and CBCT localization systems, both in phantom and patient. A procedure was developed to mitigate this systematic discrepancy. CONCLUSIONS:These findings have justified our patient localization tolerance levels of 2 mm translation and 1 degree rotation for spine SRS treatment.

Mutations in the arginine vasopressin receptor 2 (AVPR2) gene can cause X-linked nephrogenic diabetes insipidus (NDI) characterized by the production of large amounts of urine and an inability to concentrate urine in response to the antidiuretic hormone vasopressin. We have identified a novel mutation in the AVPR2 gene (L170P) located in the fourth transmembrane domain in a Danish NDI male. Analysis of the mutant receptor in Madin-Darby Canine Kidney cell culture revealed that AVPR2-L170P was retained in the endoplasmic reticulum, and the expression was dramatically downregulated compared to wild-type AVPR2. Inhibition of the lysosome resulted in increased intracellular accumulation of AVPR2-L170P, indicating that AVPR2-L170P is downregulated via the lysosome. Inhibition of the proteasome resulted in plasma membrane localization of AVPR2-L170P, although the overall levels of AVPR2-L170P were unchanged.