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Associations between anthropometric factors and breast cancer (BC) risk have varied inconsistently by estrogen and/or progesterone receptor (ER/PR) status. Associations between prediagnostic anthropometric factors and risk of premenopausal and postmenopausal BC overall and ER/PR status subtypes were investigated in a pooled analysis of 20 prospective cohorts, including 36,297 BC cases among 1,061,915 women, using multivariable Cox regression analyses, controlling for reproductive factors, diet and other risk factors. We estimated dose-response relationships and tested for nonlinear associations using restricted cubic splines. Height showed positive, linear associations for premenopausal and postmenopausal BC risk (6-7% RR increase per 5 cm increment), with stronger associations for receptor-positive subtypes. Body mass index (BMI) at cohort baseline was strongly inversely associated with premenopausal BC risk, and strongly positively-and nonlinearly-associated with postmenopausal BC (especially among women who never used hormone replacement therapy). This was primarily observed for receptor-positive subtypes. Early adult BMI (at 18-20 years) showed inverse, linear associations for premenopausal and postmenopausal BC risk (21% and 11% RR decrease per 5 kg/m2, respectively) with stronger associations for receptor-negative subtypes. Adult weight gain since 18-20 years was positively associated with postmenopausal BC risk, stronger for receptor-positive subtypes, and among women who were leaner in early adulthood. Women heavier in early adulthood generally had reduced premenopausal BC risk, independent of later weight gain. Positive associations between height, baseline (adult) BMI, adult weight gain and postmenopausal BC risk were substantially stronger for hormone receptor-positive versus negative subtypes. Premenopausal BC risk was positively associated with height, but inversely with baseline BMI and weight gain (mostly in receptor-positive subtypes). Inverse associ

Associations between anthropometric factors and breast cancer (BC) risk have varied inconsistently by estrogen and/or progesterone receptor (ER/PR) status. Associations between prediagnostic anthropometric factors and risk of premenopausal and postmenopausal BC overall and ER/PR status subtypes were investigated in a pooled analysis of 20 prospective cohorts, including 36,297 BC cases among 1,061,915 women, using multivariable Cox regression analyses, controlling for reproductive factors, diet and other risk factors. We estimated dose-response relationships and tested for nonlinear associations using restricted cubic splines. Height showed positive, linear associations for premenopausal and postmenopausal BC risk (6-7% RR increase per 5 cm increment), with stronger associations for receptor-positive subtypes. Body mass index (BMI) at cohort baseline was strongly inversely associated with premenopausal BC risk, and strongly positively-and nonlinearly-associated with postmenopausal BC (especially among women who never used hormone replacement therapy). This was primarily observed for receptor-positive subtypes. Early adult BMI (at 18-20 years) showed inverse, linear associations for premenopausal and postmenopausal BC risk (21% and 11% RR decrease per 5 kg/m2, respectively) with stronger associations for receptor-negative subtypes. Adult weight gain since 18-20 years was positively associated with postmenopausal BC risk, stronger for receptor-positive subtypes, and among women who were leaner in early adulthood. Women heavier in early adulthood generally had reduced premenopausal BC risk, independent of later weight gain. Positive associations between height, baseline (adult) BMI, adult weight gain and postmenopausal BC risk were substantially stronger for hormone receptor-positive versus negative subtypes. Premenopausal BC risk was positively associated with height, but inversely with baseline BMI and weight gain (mostly in receptor-positive subtypes). Inverse associ

Background: Oral squamous cell carcinoma (SCC) with cardiac metastasis is a rare antemortem finding. A case demonstrating significant right ventricular (RV) cavity obliteration due to metastatic SCC in an asymptomatic patient is presented. Case Summary: A 46-year-old gentleman underwent routine preoperative electrocardiogram which raised concern of possible anterior and inferior ST elevation (Image 1A). Clinically he had no chest pain but a 2-week history of night sweats, anorexia and weight loss. This was on a background of meta-static floor of mouth SCC treated with neoadjuvant carboplatin/paclitaxel chemotherapy and wide local excision of the floor of the mouth, subtotal glossectomy, segmental mandibulectomy, left sided selective lymph node dissection, and right modified radical neck dissection. Histopathology revealed T4aN2cM0 locally advanced SCC. Clinical examination was unremarkable except for a JVP with a prominent 'a' wave and a pericardial friction rub. Investigations revealed a normal Troponin (<0.04 ng/ml). CT Pulmonary Angiogram demonstrated a large pericardial effusion, a large filling defect (49x45mm) within the RV, multiple enlarged mediastinal and anterior pericardial lymph nodes. Several lung nodules were found bilaterally (largest 14x17mm). FDG-PET scan demonstrated an intensely avid mass involving the myocardium, the interventricular septum and floor of the ventricle (Image 1D). Nodular FDG avid pericardial disease and bilateral pulmonary metastases were noted in addition to uptake in the subcutaneous soft tissues anterior to the left oropharynx (SUV max 6). Urgent transtho-racic echocardiogram revealed moderate right ventricular (RV) dilation, with a large lobulated echodense mass invading the RV free wall, occupying most of the RV cavity (Image 1B & C). Estimated RV systolic pressure was 32 mmHg. A moderate circumferential pericardial effusion was detected, measuring 25 mm in diameter posteriorly with no tamponade physiology. Management: A pres

Background: Long term diuretic therapy (combination of hydrochlorothiazide [HcT] and spironolactone [Sp]) is commonly used to prevent or treat CLD, with the objective to improve gas exchange and reduce the need for respiratory support. This study aimed to assess respiratory efficacy of HcT and sp, and ascertain any unintended adverse effects. Method(s): Single centre data from 2014-2018 was analysed for infants <28 weeks' gestational age (GA), administered oral diuretics. Impact on respiratory support, weight gain and electrolyte status was assessed. Result(s): Of 491 infants, 117 (24%) were administered diuretics for evolving or established CLD. GA and birthweight of the cohort were 25.7 +/- 1.1 weeks and 779 +/- 172 g, respectively. Median (interquartile) chronological age and GA at the start of diuretics was 45 (22, 62) days and 32.1 (30.1, 35.1) weeks, respectively. In 71/117 (61%) infants, diuretics were started at <36 weeks GA; only 8 (6.8%) of these did not develop CLD. No improvement was noted in respiratory parameters (distending pressure, cm of H2O, [8.8 +/- 0.4 vs 8.8 +/- 0.5, P = 0.39] and oxygen requirement, % [32 +/- 1 vs 30 +/- 1, P = 0.07]). Ninety-eight (84%) infants developed hyponatremia (<135 mmol/L;<130 mmol/L in 45/98); sodium supplements were required in 58/98 (59%) infants. 39 infants developed hypophosphatemia (<1.8 mmol/L) needing supplementation. Weight gain over a week (g/kg/day) slowed down significantly (18.2 +/- 2.1 to 10 +/- 2.9, P = <0.001) between before and after diuretics. Conclusion(s): Diuretics use was not associated with improvements in respiratory support requirements but was associated with electrolyte abnormalities and deceleration in weight gain (or weight loss).

Background: Frailty during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with increased risk of readmission. Despite this, not all patients readmit, and the factors associated with readmission are not clear. Aim(s): To identify the clinical features of patients with AECOPD and frailty who experience readmissions. Method(s): Prospective cohort study of 74 patients recruited during AECOPD at a tertiary hospital in Melbourne, Australia. Frailty was defined according to Fried phenotype (slowness, weakness, exhaustion, weight loss, physical activity) evaluated early during admission. Characteristics of this group, measured during AECOPD and as change (DELTA) up to 1-month review, were compared between those who were vs were not censored due to 90-day respiratoryrelated readmission or death. Result(s): Frailty was detected in 34 (46%) of all patients with AECOPD and associated with a 4.5-fold risk of readmission c.f. non-frail patients (p=0.008). Key findings between those who were (n=15 [44%]) or were not (n=19 [56%]) censored are presented in the table. Discussion(s): Frailty is a highly prevalent, clinically important trait to detect during AECOPD. Follow-up evaluation of frail patients after discharge may be indicated to better detect those at high risk of readmission.

Background: Oral squamous cell carcinoma (SCC) with cardiac metastasis is a rare antemortem finding. A case demonstrating significant right ventricular (RV) cavity obliteration due to metastatic SCC in an asymptomatic patient is presented. Case Summary: A 46-year-old gentleman underwent routine preoperative electrocardiogram which raised concern of possible anterior and inferior ST elevation (Image 1A). Clinically he had no chest pain but a 2-week history of night sweats, anorexia and weight loss. This was on a background of meta-static floor of mouth SCC treated with neoadjuvant carboplatin/paclitaxel chemotherapy and wide local excision of the floor of the mouth, subtotal glossectomy, segmental mandibulectomy, left sided selective lymph node dissection, and right modified radical neck dissection. Histopathology revealed T4aN2cM0 locally advanced SCC. Clinical examination was unremarkable except for a JVP with a prominent 'a' wave and a pericardial friction rub. Investigations revealed a normal Troponin (<0.04 ng/ml). CT Pulmonary Angiogram demonstrated a large pericardial effusion, a large filling defect (49x45mm) within the RV, multiple enlarged mediastinal and anterior pericardial lymph nodes. Several lung nodules were found bilaterally (largest 14x17mm). FDG-PET scan demonstrated an intensely avid mass involving the myocardium, the interventricular septum and floor of the ventricle (Image 1D). Nodular FDG avid pericardial disease and bilateral pulmonary metastases were noted in addition to uptake in the subcutaneous soft tissues anterior to the left oropharynx (SUV max 6). Urgent transtho-racic echocardiogram revealed moderate right ventricular (RV) dilation, with a large lobulated echodense mass invading the RV free wall, occupying most of the RV cavity (Image 1B & C). Estimated RV systolic pressure was 32 mmHg. A moderate circumferential pericardial effusion was detected, measuring 25 mm in diameter posteriorly with no tamponade physiology. Management: A pres

Background: Long term diuretic therapy (combination of hydrochlorothiazide [HcT] and spironolactone [Sp]) is commonly used to prevent or treat CLD, with the objective to improve gas exchange and reduce the need for respiratory support. This study aimed to assess respiratory efficacy of HcT and sp, and ascertain any unintended adverse effects. Method(s): Single centre data from 2014-2018 was analysed for infants <28 weeks' gestational age (GA), administered oral diuretics. Impact on respiratory support, weight gain and electrolyte status was assessed. Result(s): Of 491 infants, 117 (24%) were administered diuretics for evolving or established CLD. GA and birthweight of the cohort were 25.7 +/- 1.1 weeks and 779 +/- 172 g, respectively. Median (interquartile) chronological age and GA at the start of diuretics was 45 (22, 62) days and 32.1 (30.1, 35.1) weeks, respectively. In 71/117 (61%) infants, diuretics were started at <36 weeks GA; only 8 (6.8%) of these did not develop CLD. No improvement was noted in respiratory parameters (distending pressure, cm of H2O, [8.8 +/- 0.4 vs 8.8 +/- 0.5, P = 0.39] and oxygen requirement, % [32 +/- 1 vs 30 +/- 1, P = 0.07]). Ninety-eight (84%) infants developed hyponatremia (<135 mmol/L;<130 mmol/L in 45/98); sodium supplements were required in 58/98 (59%) infants. 39 infants developed hypophosphatemia (<1.8 mmol/L) needing supplementation. Weight gain over a week (g/kg/day) slowed down significantly (18.2 +/- 2.1 to 10 +/- 2.9, P = <0.001) between before and after diuretics. Conclusion(s): Diuretics use was not associated with improvements in respiratory support requirements but was associated with electrolyte abnormalities and deceleration in weight gain (or weight loss).

Background: Frailty during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with increased risk of readmission. Despite this, not all patients readmit, and the factors associated with readmission are not clear. Aim(s): To identify the clinical features of patients with AECOPD and frailty who experience readmissions. Method(s): Prospective cohort study of 74 patients recruited during AECOPD at a tertiary hospital in Melbourne, Australia. Frailty was defined according to Fried phenotype (slowness, weakness, exhaustion, weight loss, physical activity) evaluated early during admission. Characteristics of this group, measured during AECOPD and as change (DELTA) up to 1-month review, were compared between those who were vs were not censored due to 90-day respiratoryrelated readmission or death. Result(s): Frailty was detected in 34 (46%) of all patients with AECOPD and associated with a 4.5-fold risk of readmission c.f. non-frail patients (p=0.008). Key findings between those who were (n=15 [44%]) or were not (n=19 [56%]) censored are presented in the table. Discussion(s): Frailty is a highly prevalent, clinically important trait to detect during AECOPD. Follow-up evaluation of frail patients after discharge may be indicated to better detect those at high risk of readmission.

IgG4 related sclerosing disease is a fairly newly recognised fibro-inflammatory condition that was only initially observed in autoimmune pancreatitis. However, recent observations have shown similar findings described in virtually every organ system. We report a case of suspected IgG4 related disease mimicking an extensive rectal adenocarcinoma. A 54-year-old man presented with a five month history of lower abdominal pain associated with a 4 kg loss of weight. A CT colonography showed an annular mass projecting into the rectum with luminal narrowing. The sigmoid colon showed gross thickening, diverticula, fibrosis and stranding in the adjacent fat. The roof of the bladder was also grossly thickened. A pelvic exenteration with ileal conduit and ileostomy was performed. The sections of colonic mucosa showed multiple diverticula with ulceration, storiform fibrosis and abscess formation as well as a dense inflammatory cell infiltrate comprised of plasma cells and lymphocytes. These changes extended into the bladder and prostatic tissue. Immunohistochemical stains for IgG4 showed areas of increased plasma cells staining suggesting a relationship to IgG4 sclerosing disease. Despite IgG4 being fairly new, IgG4 related sclerosing disease should be considered as a possible clinical and radiological mimic of malignancy to avoid unnecessary resections.Copyright © 2018

Introduction: To describe a case of nitrofurantoin associated organising pneumonia. Background(s): Nitrofurantoin is an antibacterial agent indicated for treatment of uncomplicated urinary tract infection (UTI) or for prophylaxis in those patients with recurrent UTIs. It is rarely used as a first line agent owing to its potential for adverse reactions such as pulmonary toxicity.1 Organising pneumonia is a pathological syndrome associated with dyspnoea, non-productive cough, bilateral crackles on chest examination and hypoxaemia at rest.2 We report a case of nitrofurantoin associated organising pneumonia responsive to drug withdrawal and corticosteroid initiation, this is a rare occurrence, with only a few reported cases worldwide. Interventions, Case Progress and Outcomes: A 73-year-old female ex-smoker with a history of multiple allergies, Graves' disease, and recurrent UTIs who was treated with long-term nitrofurantoin presented with an 8- week history of worsening dyspnoea on exertion, pleuritic chest pain when coughing, nausea, decreasing appetite, weight loss and increasing lethargy. Computed Tomography (CT) of the chest revealed widespread bilateral airspace and peribronchovascular ground glass opacities indicative of organising pneumonia. Following diagnosis of organising pneumonia, nitrofurantoin was ceased and high dose prednisolone commenced. After rapid clinical response to treatment, the patient was discharged long-term on high dose prednisolone. On routine 4-week follow up, the patient's symptoms had improved significantly. A repeat CT chest demonstrated dramatic reduction in ground glass changes. Conclusion(s): Nitrofurantoin associated organising pneumonia is a rarely reported adverse reaction and is often associated with poor outcomes. 3 This case report highlights that nitrofurantoin associated organising pneumonia can improve dramatically with prompt withdrawal of the causative agent and commencement of corticosteroids. It also reinforces the impor

Background: To develop and translate rigorous, comprehensive evidence-based diagnosis, assessment and treatment guidelines to improve the lives of women with polycystic ovary syndrome (PCOS) worldwide. Method(s): Extensive multidisciplinary health professional and patient engagement informed guideline priority areas. Best practice evidence-based guideline development involved extensive evidence synthesis. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework covered evidence quality, feasibility, acceptability, cost, implementation and recommendation strength. Governance included international advisory board (six continents), project board, five guideline development groups (GDG) with 63 members, consumer and translation committees. Thirty-seven organisations across 71 countries collaborated with 23 face-to-face international meetings over 15 months. Convened Committees from partner and collaborating organisations provided peer review and the guideline was approved by the NHMRC. This abstract focuses on the lifestyle management and models of care GDG. Result(s): Women with PCOS should be offered regular weight monitoring. Healthy lifestyle (diet, exercise and behavioural strategies) behaviours should be recommended in all women with PCOS to achieve and/or maintain healthy weight and to optimise hormonal outcomes, general health and quality of life across the life-course. 5-10% weight loss in those with excess weight yields significant clinical improvements and is considered successful weight reduction within six months Health professionals should advise standard population recommendation for diet composition, physical activity and sedentary behaviour. Lifestyle interventions could include behavioural strategies or health behavioural or cognitive behavioural interventions. Personal sensitivities, marginalisation and potential weight-related stigma and psychological factors such as anxiety and depressive symptoms, body image concerns an

Introduction: Very Low Calorie Diets (VLCD) have been demonstrated to achieve rapid and significant weight loss in obese people without kidney disease. However, there is no published evidence on the use of VLCD in end-stage kidney disease (ESKD) patients. Current manufacturers' guidelines state the meal replacement VLCD are contra-indicated in patients with impaired kidney function (eGFR <60ml/min). The aim of the study is to determine if the use of a VLCD with 3 meal replacements is safe and effective for weight loss in patients with ESKD treated with haemodialysis (HD). Method(s): 22 HD patients (9 home HD, 13 centre HD) with BMIs >30 were recruited and consented to the study. All were placed on a VLCD of 600-800 kcals. Subjects were monitored weekly for 4 weeks, and then fortnightly for the remainder of the study period (12 weeks in total). Pre and post dialysis weight, intradialytic fluid gain, biochemistry, ketones, and compliance with the VLCD plan were monitored each visit by nursing staff and dietitians. Dialysis prescriptions and medications were altered as medically required. Nutritional assessments, quality of life surveys, waist measurements, transthyretin and HbA1c were collected at baseline and completion of the study. Data was assessed using paired t-test and a mixed models where appropriate. All patients were included in the analysis. Result(s): Of the 22 patients recruited, 19 patients completed the 12 week treatment course. Three patients withdrew as they were found it difficult to maintain the study meal plans (at week 5, 6 and 10). Mean age was 49.7 years (SD 7.4), 40.1% were female, and 45.5% diabetic. Home HD patients were treated with alternate days HD 8 hours while centre HD were treated with 5 hour sessions 3 times per week. Mean pre dialysis weight was 121.1 kg (SD 28.4) at baseline. Throughout the study period pre-dialysis weight declined by 0.91 kg per week (95% C.I. 0.74 - 1.08, p<0.001). When assessed according to dialysis modality, rat

Background: Malignant Pleural Mesothelioma (MPM) is a rare but fatal disease related to asbestos exposure, with historic survival in the order of 9 to 17 months. Chemotherapy is associated with only a modest benefit. The advent of immunotherapy has heralded significantly improved outcomes using checkpoint inhibitors in an as yet ill-defined cohort. We aim to identify predictive and prognostic biomarkers in a series of patients (pts) with MPM and describe survival data. Method(s):A retrospective audit was undertaken of pts with MPM diagnosed between 2013 and 2017 at a single tertiary centre in Melbourne, Australia (Monash Health). Data relating to patient outcomes and clinicopathological features were obtained through medical reports. Further immunostains are being performed on archived tissue for PDL-1 status. Result(s): 65 pts were identified, of whom 52 (80.0%) were male. Median age was 73 years (range 44-90). 52 pts were noted to be ECOG 0-1. 42 pts (64.6%) were noted to have suspected asbestos exposure. Epithelioid MPM was the most common subtype, noted in 41 pts (63.1%) (table 1). 8 pts (12.3%) presented with stage IV disease. 16 pts (24.6%) received checkpoint inhibitor therapy, with 10 (63 %) in the second/third line setting. Median overall survival (OS) was 19.8 months (95% CI 13.3-26.3) in the whole cohort.Patient characteristics associated with poor OS were: presence of weight loss (P = 0.001), chest pain (p = 0.08) and ECOG 2 (p = 0.04). Pts with sarcomatoid histology who received immune checkpoint inhibitors in any line of treatment had significantly prolonged OS compared to other histologies. 3-year survival was 80% in this group while median OS was not reached (p = 0.04). This difference was not seen with other histologies. Conclusion(s): The evolving landscape of treatment in MPM appears to show promise in improving OS. In this unselected case series, our data is consistent with historic controls in terms of survival and prognostic factors. The findin

IgG4 related sclerosing disease is a fairly newly recognised fibro-inflammatory condition that was only initially observed in autoimmune pancreatitis. However, recent observations have shown similar findings described in virtually every organ system. We report a case of suspected IgG4 related disease mimicking an extensive rectal adenocarcinoma. A 54-year-old man presented with a five month history of lower abdominal pain associated with a 4 kg loss of weight. A CT colonography showed an annular mass projecting into the rectum with luminal narrowing. The sigmoid colon showed gross thickening, diverticula, fibrosis and stranding in the adjacent fat. The roof of the bladder was also grossly thickened. A pelvic exenteration with ileal conduit and ileostomy was performed. The sections of colonic mucosa showed multiple diverticula with ulceration, storiform fibrosis and abscess formation as well as a dense inflammatory cell infiltrate comprised of plasma cells and lymphocytes. These changes extended into the bladder and prostatic tissue. Immunohistochemical stains for IgG4 showed areas of increased plasma cells staining suggesting a relationship to IgG4 sclerosing disease. Despite IgG4 being fairly new, IgG4 related sclerosing disease should be considered as a possible clinical and radiological mimic of malignancy to avoid unnecessary resections.Copyright © 2018

Introduction: To describe a case of nitrofurantoin associated organising pneumonia. Background(s): Nitrofurantoin is an antibacterial agent indicated for treatment of uncomplicated urinary tract infection (UTI) or for prophylaxis in those patients with recurrent UTIs. It is rarely used as a first line agent owing to its potential for adverse reactions such as pulmonary toxicity.1 Organising pneumonia is a pathological syndrome associated with dyspnoea, non-productive cough, bilateral crackles on chest examination and hypoxaemia at rest.2 We report a case of nitrofurantoin associated organising pneumonia responsive to drug withdrawal and corticosteroid initiation, this is a rare occurrence, with only a few reported cases worldwide. Interventions, Case Progress and Outcomes: A 73-year-old female ex-smoker with a history of multiple allergies, Graves' disease, and recurrent UTIs who was treated with long-term nitrofurantoin presented with an 8- week history of worsening dyspnoea on exertion, pleuritic chest pain when coughing, nausea, decreasing appetite, weight loss and increasing lethargy. Computed Tomography (CT) of the chest revealed widespread bilateral airspace and peribronchovascular ground glass opacities indicative of organising pneumonia. Following diagnosis of organising pneumonia, nitrofurantoin was ceased and high dose prednisolone commenced. After rapid clinical response to treatment, the patient was discharged long-term on high dose prednisolone. On routine 4-week follow up, the patient's symptoms had improved significantly. A repeat CT chest demonstrated dramatic reduction in ground glass changes. Conclusion(s): Nitrofurantoin associated organising pneumonia is a rarely reported adverse reaction and is often associated with poor outcomes. 3 This case report highlights that nitrofurantoin associated organising pneumonia can improve dramatically with prompt withdrawal of the causative agent and commencement of corticosteroids. It also reinforces the impor

Background: To develop and translate rigorous, comprehensive evidence-based diagnosis, assessment and treatment guidelines to improve the lives of women with polycystic ovary syndrome (PCOS) worldwide. Method(s): Extensive multidisciplinary health professional and patient engagement informed guideline priority areas. Best practice evidence-based guideline development involved extensive evidence synthesis. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework covered evidence quality, feasibility, acceptability, cost, implementation and recommendation strength. Governance included international advisory board (six continents), project board, five guideline development groups (GDG) with 63 members, consumer and translation committees. Thirty-seven organisations across 71 countries collaborated with 23 face-to-face international meetings over 15 months. Convened Committees from partner and collaborating organisations provided peer review and the guideline was approved by the NHMRC. This abstract focuses on the lifestyle management and models of care GDG. Result(s): Women with PCOS should be offered regular weight monitoring. Healthy lifestyle (diet, exercise and behavioural strategies) behaviours should be recommended in all women with PCOS to achieve and/or maintain healthy weight and to optimise hormonal outcomes, general health and quality of life across the life-course. 5-10% weight loss in those with excess weight yields significant clinical improvements and is considered successful weight reduction within six months Health professionals should advise standard population recommendation for diet composition, physical activity and sedentary behaviour. Lifestyle interventions could include behavioural strategies or health behavioural or cognitive behavioural interventions. Personal sensitivities, marginalisation and potential weight-related stigma and psychological factors such as anxiety and depressive symptoms, body image concerns an

Introduction: Very Low Calorie Diets (VLCD) have been demonstrated to achieve rapid and significant weight loss in obese people without kidney disease. However, there is no published evidence on the use of VLCD in end-stage kidney disease (ESKD) patients. Current manufacturers' guidelines state the meal replacement VLCD are contra-indicated in patients with impaired kidney function (eGFR <60ml/min). The aim of the study is to determine if the use of a VLCD with 3 meal replacements is safe and effective for weight loss in patients with ESKD treated with haemodialysis (HD). Method(s): 22 HD patients (9 home HD, 13 centre HD) with BMIs >30 were recruited and consented to the study. All were placed on a VLCD of 600-800 kcals. Subjects were monitored weekly for 4 weeks, and then fortnightly for the remainder of the study period (12 weeks in total). Pre and post dialysis weight, intradialytic fluid gain, biochemistry, ketones, and compliance with the VLCD plan were monitored each visit by nursing staff and dietitians. Dialysis prescriptions and medications were altered as medically required. Nutritional assessments, quality of life surveys, waist measurements, transthyretin and HbA1c were collected at baseline and completion of the study. Data was assessed using paired t-test and a mixed models where appropriate. All patients were included in the analysis. Result(s): Of the 22 patients recruited, 19 patients completed the 12 week treatment course. Three patients withdrew as they were found it difficult to maintain the study meal plans (at week 5, 6 and 10). Mean age was 49.7 years (SD 7.4), 40.1% were female, and 45.5% diabetic. Home HD patients were treated with alternate days HD 8 hours while centre HD were treated with 5 hour sessions 3 times per week. Mean pre dialysis weight was 121.1 kg (SD 28.4) at baseline. Throughout the study period pre-dialysis weight declined by 0.91 kg per week (95% C.I. 0.74 - 1.08, p<0.001). When assessed according to dialysis modality, rat

Background: Malignant Pleural Mesothelioma (MPM) is a rare but fatal disease related to asbestos exposure, with historic survival in the order of 9 to 17 months. Chemotherapy is associated with only a modest benefit. The advent of immunotherapy has heralded significantly improved outcomes using checkpoint inhibitors in an as yet ill-defined cohort. We aim to identify predictive and prognostic biomarkers in a series of patients (pts) with MPM and describe survival data. Method(s):A retrospective audit was undertaken of pts with MPM diagnosed between 2013 and 2017 at a single tertiary centre in Melbourne, Australia (Monash Health). Data relating to patient outcomes and clinicopathological features were obtained through medical reports. Further immunostains are being performed on archived tissue for PDL-1 status. Result(s): 65 pts were identified, of whom 52 (80.0%) were male. Median age was 73 years (range 44-90). 52 pts were noted to be ECOG 0-1. 42 pts (64.6%) were noted to have suspected asbestos exposure. Epithelioid MPM was the most common subtype, noted in 41 pts (63.1%) (table 1). 8 pts (12.3%) presented with stage IV disease. 16 pts (24.6%) received checkpoint inhibitor therapy, with 10 (63 %) in the second/third line setting. Median overall survival (OS) was 19.8 months (95% CI 13.3-26.3) in the whole cohort.Patient characteristics associated with poor OS were: presence of weight loss (P = 0.001), chest pain (p = 0.08) and ECOG 2 (p = 0.04). Pts with sarcomatoid histology who received immune checkpoint inhibitors in any line of treatment had significantly prolonged OS compared to other histologies. 3-year survival was 80% in this group while median OS was not reached (p = 0.04). This difference was not seen with other histologies. Conclusion(s): The evolving landscape of treatment in MPM appears to show promise in improving OS. In this unselected case series, our data is consistent with historic controls in terms of survival and prognostic factors. The findin

Aim. DEXA scans allow for measurement of body composition (fat mass, lean muscle mass, bone mineral content(BMC)) and also specify distribution of each component. To determine body composition changes in lupus patients that gained/lost significant weight over time, and determine effect of glucocorticoids. Method. Patients of the Monash Lupus Cohort 2007-2015 that were enrolled for at least 12 months and had at least two DEXA with minimum 1 year separation. Body Composition data was extracted from radiological files. Significant weight change was defined as >7% change from baseline. Result. 68 patients were included in this study. Mean time between scans was 3.4 years. 16% gained significant weight and 15% lost significant weight during the study. Comparing the three groups (weight gain; weight loss; minimal change) there were no significant differences in body composition at baseline. Overall, there was very little difference in change in body composition and distribution. The weight loss group had lower total fat mass and total lean muscle mass (-7909g and-2777g respectively) compared to baseline. There was a reduction in both android and gynoid fat percentages compared with baseline (-9.6%,-5.31% respectively). Significant weight loss was positively associated with time-adjusted-mean-prednisolone >4.42mg/day (OR 4.66, p=0.02) and negatively associated with Asian ethnicity (OR 0.07, p=0.01) in multivariate analysis. The weight gain group had increases in total fat mass with minimal change in other components. There was an increase in both android and gynoid fat percentage compared with baseline (10.3% and 6.4%). Significant weight gain was negatively associated with Asian ethnicity (OR 0.23, p=0.02) and positively associated with higher baseline ESR (OR6.28, p<0.01) and neutrophilia (OR 6.58, p<0.01) in multivariate analysis. Conclusions. Weight loss occurred in both fat and muscle components and was associated with higher glucocorticoid exposure. Asian ethnicity w

Introduction: Intestinal tuberculosis (ITB) and Crohn's disease may be clinically indistinguishable, and diagnostic tests for TB have low sensitivities of <50%. Consequences of misdiagnosis can be fatal, and treatment delays due to diagnostic uncertainty result in significant morbidity. Empirical antimicrobial therapy is generally commenced in high-burden countries, but concerns arise regarding TB resistance and treatment-related side effects. Recently, a meta-analytical Bayesian model for differentiating ITB from Crohn's disease has been published and validated in a Thailand cohort, with a sensitivity of 90.9%.1 However, the local prevalence of ITB is unknown in Victoria and must be established in order to apply this model. Aim(s): Our aims were to identify the prevalence of ITB in an at-risk popu-lation with inflammatory bowel disease (IBD) in our multicultural health services; to describe the features of patients with ITB in Victoria; and to evaluate a meta-analytical Bayesian model for differentiating ITB from Crohn's disease. Method(s): A retrospective patient cohort with confirmed ITB between 2003 and 2017 was identified at our institutions using data from the Victorian Tuberculosis Program database and hospital medical records. Diagnosis of ITB required the following pathological criteria: (1) acid-fast bacilli (AFB) or caeseating granuloma(s), (2) culture of Mycobacte-rium tuberculosis, (3) proven TB elsewhere in the body, or (4) clinical and endoscopic response to anti-tuberculosis therapy without recurrence. Medians and proportions were used to analyze descriptive data. The prevalence of ITB was approximated using the number of ITB cases established and the population of patients attending IBD clinics who were born in high-TB-burden countries from 2003 to 2017. These were defined as countries where the rates of TB were >=40 cases per 100 000 persons, as per the World Health Organization (WHO) Global Tuberculosis Report 2017. Result(s): Interim results reve

Aim: Low survival rates for oesophageal cancer (OC) have increased the focus on treatment pathways for this cancer. This study examines treatment of OC in Victoria prior to the implementation of Optimal Care Pathways (OCP) that aim to reduce care variations. Method(s): A population-based cohort of patients diagnosed with OC between January 1, 2015 and June 31, 2016 was identified through the Victorian Cancer Registry. Trained research assistants attended each patient's treatment centre to extract details relating to patient demographics, symptoms, treatments and outcomes from their medical record. Chi-square analyses examined diagnostic and treatment differences between groups and nonparametric tests examined differences between groups for when distributions were not normal. Result(s): To date, complete data for 291 of 507 eligible patients has been collected. Eighty-two percent of patients [age (years), 71 +/- 12.0; 70% male] were symptomatic at diagnosis [dysphagia (69%); weight loss (52%)]. Twenty-five percent were diagnosed with localised (T1-T3, N0, M0), 33% locally advanced (T4; T1-3, N1-3, M0) and 31% metastatic disease (M1). Fifty-eight percent were discussed at multidisciplinary meetings (MDM); less likely for patients >75 years (p < 0.01) or metastatic disease (p = 0.025). Median (quartile) time from diagnosis to MDM [17.0 days (7.0, 30.0)] and from MDM to first treatment [25.0 days; (10.5, 38.5)] were greater than OCP recommendations (both 14 days) and both intervals were shorter for metastatic [diagnosis-MDM (10 days); MDM-treatment (18.5 days)] than nonmetastic [diagnosis-MDM (18.5 days); MDM-treatment (28.0 days]) disease (p < 0.05). Nine percent of patients were enrolled in a clinical trial which was more common for those discussed at a MDM (15% vs 2%, p < 0.01). Thirty-one percent of localised disease had surgery with three cases (all >=75 years) not having treatment. Of ambulant patients with locally advanced disease, 81% received chemotherapy and 3

Background: Obesity is the strongest risk factor for developing obstructive sleep apnoea (OSA). Prior studies have shown that weight loss is associated with reductions in upper airway collapsibility, however, we do not know how obesity alters other physiological traits which are known to cause OSA; namely (a) the ability of the pharyngeal muscles to activate or reopen the airway during sleep (muscle compensation), (b) the respiratory arousal threshold, and (c) the ventilatory control system (i.e. loop gain). Furthermore, the-gold standard' technique to obtain these OSA traits (i.e. invasive phenotyping using continuous positive airway pressure [CPAP] manipulations) can be labour-intensive and cumbersome. Therefore, the aim of this study is to examine how surgical weight loss affects these OSA traits using non-invasive phenotyping (derived from the clinical polysomnogram [PSG]). Method(s): A retrospective analysis of 15 participants (i.e. demographics and clinical PSG: baseline, 9 and 18-months post-surgery) who received bariatric surgery. OSA traits were measured using our non-invasive phenotyping software on the pre-and post-surgery clinical PSGs. Values are presented as mean +/- standard deviation or median [interquartile range]. Result(s): Overall, participants lost 15.5 +/- 8.9 kg and had a reduction in apnoea-hypopnoea index (AHI) of 23.0 +/- 15.9 events/hr from baseline to 18-months post-surgery. Weight loss following surgery led to an improvement in muscle compensation between 9-months (5.5 [10.1]%) and 18-months (7.5 [8.8]% of eupnoeic ventilation, p < 0.05, baseline = 3.4 [12]% eupnoeic ventilation). Surprisingly, no significant improvements in upper airway collapsibility were found, nor were there any changes in the arousal threshold or loop gain from baseline to 9 or 18-months. Discussion(s): Our preliminary findings showed that weight loss improved muscle compensation but had no significant impact on the other OSA traits. A greater degree of weight loss

Aim: To characterise hemodialysis patients by BMI trajectories over the course of treatment and their association with the rates of transplant and death without transplant. Background(s): The relationship between body mass index (BMI) and patient survival in end-stage kidney disease in not well understood and has been the subject of much debate over recent years. Method(s): This study used a latent class joint modelling approach to identify latent groups that underpinned associations between patterns of change in BMI during hemodialysis and two competing events: Transplant and death without transplant. We included all adult patients who initiated chronic hemodialysis treatment in Australia or New Zealand between 2005 and 2014. Result(s): There were 16,414 patients included in the analyses; 2427 (14%) received a transplant, 6142 (35%) died prior to transplant, and 9122 (52%) were administratively censored. Our final model characterised patients based on five broad patterns of weight change (BMI trajectories): A "late BMI decline" (about two years after commencing hemodialysis); a "rapid BMI decline" (immediately after commencing hemodialysis); a "stable and normal or overweight BMI"; a "stable and morbidly obese BMI"; or an "increasing BMI". Mortality rates were highest amongst classes with declining BMI, and the timing of weight loss coincided with the timing of increases in mortality. The two stable BMI classes had relatively similar mortality rates, regardless of starting BMI (normal/overweight, or morbidly obese). Conclusion(s): Our results suggest that obesity is not necessarily protective in hemodialysis, but that the BMI trajectory is important, independent of BMI at dialysis initiation. Future research should be aimed at understanding the causes of weight changes during dialysis, to determine whether there could be strategies to improve patient survival.

Objectives: Obese infertile women are at risk for sexual dysfunction. A preconception lifestyle intervention in these women led to short-term weight reduction, a reduction in metabolic syndrome, more natural conceptions and improved physical quality of life. Here, we study whether a preconception lifestyle intervention in obese, infertile women led to improved sexual function. Method(s): Women who participated in the Dutch 'LIFEstyle' multicentre RCT between 2009-2014 were eligible for this follow-up study. Infertile women aged 18-39 years with a BMI>=29 kg/m2 (n=577) were randomised between a six-month preconception lifestyle intervention targeting physical activity, diet and behaviour or prompt infertility care. 5-6 years later, we assessed sexual function with the McCoy Female Sexuality Questionnaire. We performed logistic and linear regression comparing the intervention to the control group, adjusting for duration of infertility, PCOS status and child wish. Result(s): The intervention group (n=84) more often had intercourse in the past 4 weeks compared to the control group (n=93) (OR 2.3; CI 1.0-5.7). Within the intercourse reporting women, the intervention group (n=75) had a statistically higher intercourse frequency (6.6+/-5.8 vs. 4.9+/-4.0; CI 0.1-3.4) and higher scores for sexual satisfaction (11.8+/-2.6 vs. 10.9+/-2.6; CI 0.0-1.7), vaginal lubrication (16.5+/-3.0 vs. 15.4+/-3.5; CI 0.2-2.3) and total 'sexual function' (96.5+/-14.2 vs. 91.4+/-12.8; CI 0.9-9.5) compared to the controls (n=72). Sexual interest, orgasm and partner domain scores did not differ between groups. Conclusion(s): Obese infertile women reported better long-term sexual function after participation in a six-month lifestyle intervention aimed at weight reduction prior to infertility treatment. Future studies should investigate which aspects of a lifestyle intervention determine the effect on sexual function in order to tailor lifestyle interventions to improve sexual function.

Aim: Low survival rates for oesophageal cancer (OC) have increased the focus on treatment pathways for this cancer. This study examines treatment of OC in Victoria prior to the implementation of Optimal Care Pathways (OCP) that aim to reduce care variations. Method(s): A population-based cohort of patients diagnosed with OC between January 1, 2015 and June 31, 2016 was identified through the Victorian Cancer Registry. Trained research assistants attended each patient's treatment centre to extract details relating to patient demographics, symptoms, treatments and outcomes from their medical record. Chi-square analyses examined diagnostic and treatment differences between groups and nonparametric tests examined differences between groups for when distributions were not normal. Result(s): To date, complete data for 291 of 507 eligible patients has been collected. Eighty-two percent of patients [age (years), 71 +/- 12.0; 70% male] were symptomatic at diagnosis [dysphagia (69%); weight loss (52%)]. Twenty-five percent were diagnosed with localised (T1-T3, N0, M0), 33% locally advanced (T4; T1-3, N1-3, M0) and 31% metastatic disease (M1). Fifty-eight percent were discussed at multidisciplinary meetings (MDM); less likely for patients >75 years (p < 0.01) or metastatic disease (p = 0.025). Median (quartile) time from diagnosis to MDM [17.0 days (7.0, 30.0)] and from MDM to first treatment [25.0 days; (10.5, 38.5)] were greater than OCP recommendations (both 14 days) and both intervals were shorter for metastatic [diagnosis-MDM (10 days); MDM-treatment (18.5 days)] than nonmetastic [diagnosis-MDM (18.5 days); MDM-treatment (28.0 days]) disease (p < 0.05). Nine percent of patients were enrolled in a clinical trial which was more common for those discussed at a MDM (15% vs 2%, p < 0.01). Thirty-one percent of localised disease had surgery with three cases (all >=75 years) not having treatment. Of ambulant patients with locally advanced disease, 81% received chemotherapy and 3

Aim. DEXA scans allow for measurement of body composition (fat mass, lean muscle mass, bone mineral content(BMC)) and also specify distribution of each component. To determine body composition changes in lupus patients that gained/lost significant weight over time, and determine effect of glucocorticoids. Method. Patients of the Monash Lupus Cohort 2007-2015 that were enrolled for at least 12 months and had at least two DEXA with minimum 1 year separation. Body Composition data was extracted from radiological files. Significant weight change was defined as >7% change from baseline. Result. 68 patients were included in this study. Mean time between scans was 3.4 years. 16% gained significant weight and 15% lost significant weight during the study. Comparing the three groups (weight gain; weight loss; minimal change) there were no significant differences in body composition at baseline. Overall, there was very little difference in change in body composition and distribution. The weight loss group had lower total fat mass and total lean muscle mass (-7909g and-2777g respectively) compared to baseline. There was a reduction in both android and gynoid fat percentages compared with baseline (-9.6%,-5.31% respectively). Significant weight loss was positively associated with time-adjusted-mean-prednisolone >4.42mg/day (OR 4.66, p=0.02) and negatively associated with Asian ethnicity (OR 0.07, p=0.01) in multivariate analysis. The weight gain group had increases in total fat mass with minimal change in other components. There was an increase in both android and gynoid fat percentage compared with baseline (10.3% and 6.4%). Significant weight gain was negatively associated with Asian ethnicity (OR 0.23, p=0.02) and positively associated with higher baseline ESR (OR6.28, p<0.01) and neutrophilia (OR 6.58, p<0.01) in multivariate analysis. Conclusions. Weight loss occurred in both fat and muscle components and was associated with higher glucocorticoid exposure. Asian ethnicity w

Introduction: Intestinal tuberculosis (ITB) and Crohn's disease may be clinically indistinguishable, and diagnostic tests for TB have low sensitivities of <50%. Consequences of misdiagnosis can be fatal, and treatment delays due to diagnostic uncertainty result in significant morbidity. Empirical antimicrobial therapy is generally commenced in high-burden countries, but concerns arise regarding TB resistance and treatment-related side effects. Recently, a meta-analytical Bayesian model for differentiating ITB from Crohn's disease has been published and validated in a Thailand cohort, with a sensitivity of 90.9%.1 However, the local prevalence of ITB is unknown in Victoria and must be established in order to apply this model. Aim(s): Our aims were to identify the prevalence of ITB in an at-risk popu-lation with inflammatory bowel disease (IBD) in our multicultural health services; to describe the features of patients with ITB in Victoria; and to evaluate a meta-analytical Bayesian model for differentiating ITB from Crohn's disease. Method(s): A retrospective patient cohort with confirmed ITB between 2003 and 2017 was identified at our institutions using data from the Victorian Tuberculosis Program database and hospital medical records. Diagnosis of ITB required the following pathological criteria: (1) acid-fast bacilli (AFB) or caeseating granuloma(s), (2) culture of Mycobacte-rium tuberculosis, (3) proven TB elsewhere in the body, or (4) clinical and endoscopic response to anti-tuberculosis therapy without recurrence. Medians and proportions were used to analyze descriptive data. The prevalence of ITB was approximated using the number of ITB cases established and the population of patients attending IBD clinics who were born in high-TB-burden countries from 2003 to 2017. These were defined as countries where the rates of TB were >=40 cases per 100 000 persons, as per the World Health Organization (WHO) Global Tuberculosis Report 2017. Result(s): Interim results reve

Background: Obesity is the strongest risk factor for developing obstructive sleep apnoea (OSA). Prior studies have shown that weight loss is associated with reductions in upper airway collapsibility, however, we do not know how obesity alters other physiological traits which are known to cause OSA; namely (a) the ability of the pharyngeal muscles to activate or reopen the airway during sleep (muscle compensation), (b) the respiratory arousal threshold, and (c) the ventilatory control system (i.e. loop gain). Furthermore, the-gold standard' technique to obtain these OSA traits (i.e. invasive phenotyping using continuous positive airway pressure [CPAP] manipulations) can be labour-intensive and cumbersome. Therefore, the aim of this study is to examine how surgical weight loss affects these OSA traits using non-invasive phenotyping (derived from the clinical polysomnogram [PSG]). Method(s): A retrospective analysis of 15 participants (i.e. demographics and clinical PSG: baseline, 9 and 18-months post-surgery) who received bariatric surgery. OSA traits were measured using our non-invasive phenotyping software on the pre-and post-surgery clinical PSGs. Values are presented as mean +/- standard deviation or median [interquartile range]. Result(s): Overall, participants lost 15.5 +/- 8.9 kg and had a reduction in apnoea-hypopnoea index (AHI) of 23.0 +/- 15.9 events/hr from baseline to 18-months post-surgery. Weight loss following surgery led to an improvement in muscle compensation between 9-months (5.5 [10.1]%) and 18-months (7.5 [8.8]% of eupnoeic ventilation, p < 0.05, baseline = 3.4 [12]% eupnoeic ventilation). Surprisingly, no significant improvements in upper airway collapsibility were found, nor were there any changes in the arousal threshold or loop gain from baseline to 9 or 18-months. Discussion(s): Our preliminary findings showed that weight loss improved muscle compensation but had no significant impact on the other OSA traits. A greater degree of weight loss

Aim: To characterise hemodialysis patients by BMI trajectories over the course of treatment and their association with the rates of transplant and death without transplant. Background(s): The relationship between body mass index (BMI) and patient survival in end-stage kidney disease in not well understood and has been the subject of much debate over recent years. Method(s): This study used a latent class joint modelling approach to identify latent groups that underpinned associations between patterns of change in BMI during hemodialysis and two competing events: Transplant and death without transplant. We included all adult patients who initiated chronic hemodialysis treatment in Australia or New Zealand between 2005 and 2014. Result(s): There were 16,414 patients included in the analyses; 2427 (14%) received a transplant, 6142 (35%) died prior to transplant, and 9122 (52%) were administratively censored. Our final model characterised patients based on five broad patterns of weight change (BMI trajectories): A "late BMI decline" (about two years after commencing hemodialysis); a "rapid BMI decline" (immediately after commencing hemodialysis); a "stable and normal or overweight BMI"; a "stable and morbidly obese BMI"; or an "increasing BMI". Mortality rates were highest amongst classes with declining BMI, and the timing of weight loss coincided with the timing of increases in mortality. The two stable BMI classes had relatively similar mortality rates, regardless of starting BMI (normal/overweight, or morbidly obese). Conclusion(s): Our results suggest that obesity is not necessarily protective in hemodialysis, but that the BMI trajectory is important, independent of BMI at dialysis initiation. Future research should be aimed at understanding the causes of weight changes during dialysis, to determine whether there could be strategies to improve patient survival.

Objectives: Obese infertile women are at risk for sexual dysfunction. A preconception lifestyle intervention in these women led to short-term weight reduction, a reduction in metabolic syndrome, more natural conceptions and improved physical quality of life. Here, we study whether a preconception lifestyle intervention in obese, infertile women led to improved sexual function. Method(s): Women who participated in the Dutch 'LIFEstyle' multicentre RCT between 2009-2014 were eligible for this follow-up study. Infertile women aged 18-39 years with a BMI>=29 kg/m2 (n=577) were randomised between a six-month preconception lifestyle intervention targeting physical activity, diet and behaviour or prompt infertility care. 5-6 years later, we assessed sexual function with the McCoy Female Sexuality Questionnaire. We performed logistic and linear regression comparing the intervention to the control group, adjusting for duration of infertility, PCOS status and child wish. Result(s): The intervention group (n=84) more often had intercourse in the past 4 weeks compared to the control group (n=93) (OR 2.3; CI 1.0-5.7). Within the intercourse reporting women, the intervention group (n=75) had a statistically higher intercourse frequency (6.6+/-5.8 vs. 4.9+/-4.0; CI 0.1-3.4) and higher scores for sexual satisfaction (11.8+/-2.6 vs. 10.9+/-2.6; CI 0.0-1.7), vaginal lubrication (16.5+/-3.0 vs. 15.4+/-3.5; CI 0.2-2.3) and total 'sexual function' (96.5+/-14.2 vs. 91.4+/-12.8; CI 0.9-9.5) compared to the controls (n=72). Sexual interest, orgasm and partner domain scores did not differ between groups. Conclusion(s): Obese infertile women reported better long-term sexual function after participation in a six-month lifestyle intervention aimed at weight reduction prior to infertility treatment. Future studies should investigate which aspects of a lifestyle intervention determine the effect on sexual function in order to tailor lifestyle interventions to improve sexual function.