In this study, 14.2% of school-aged children showed audiometric notches or high-frequency hearing loss. This hearing impairment is already present prior to exposure to known noise hazards, such as club and concert attendance, and may have lifelong consequences. Repeated measurements are needed to confirm the association of portable music player use with hearing impairment in children.

Background: The switch to adjuvant anastrozole/exemestane after 2-3 years of tamoxifen improves breast cancer outcome. Prior to this knowledge, we designed a multicentre randomised placebo-controlled study, to evaluate uterine and quality of life (QoL) issues comparing those switching to anastrozole and those continuing on tamoxifen in patients with a thickened endometrium after 2-3 years of tamoxifen treatment. The study was prematurely closed when anastrozole/exemestane became reimbursed by our health authorities following publication of a survival benefit from the adjuvant switch strategy in this setting. We here report on all randomized patients.Patients and Methods: Patients were postmenopausal, asymptomatic with a double endometrial thickness (DET) on transvaginal ultrasound (TVUS) of more than 7 mm. They were randomized between 20mg tamoxifen and 1mg anastrozole during the rest of 5 years of endocrine treatment; tablets were unrecognizable for drug assignment. The study aimed at investigating the TVUS changes with a measurement at baseline, at year 1 and when completing the endocrine therapy unless there were QoL issues, progression or vaginal bleeding. The primary study-endpoint was the change in DET and uterine volume (UV). Secondary endpoints were differences in the occurrence of menopausal symptoms between groups. Longitudinal fixed-effects regression analysis methods were used to evaluate uterine changes and QoL scores over time. Age and BMI were used as covariates.Results: The study randomized 72 subjects (37 anastrozole and 35 tamoxifen) from 5 institutions. Mean age (range) was 60 years (43 – 77 years); demographics were comparable but patients randomized to anastrozole were more likely lymph node positive. Subjects on anastrozole had a significant decrease in mean change in DET and UV already after 1 year. Both primary endpoints did not change over time when continuing tamoxifen but between-group differences were significant (p-values < 0.001). The covariates did not influence the effect of medication. Eleven patients withdrew from the study (7 on anastrozole; 4 on tamoxifen, ns); 2 had disease progression (both on anastrozole), 1 (on tamoxifen) developed a hematologic cancer, 7 stopped because of side effects (5 on anastrozole and 2 on tamoxifen) and arthralgia being most frequently reported for early stopping (4 anastrozole and 1 tamoxifen). AEs/SAEs were observed in 54% and 11% of patients on anastrozole and in 51% and 17% of patients on tamoxifen (ns). Regarding QoL, vaginal dryness increased for patients on anastrozole but not for patients on tamoxifen (p=0.008). No different evolution of arthralgia between both groups is suggested, even though more anatrozole patients withdrew due to arthralgia problems. Vaginal bleeding was reported in 5 (3 on tamoxifen and 2 on anastrozole).Conclusion: Although the study was prematurely stopped, we were able to show a strong decrease in DET and UV in asymptomatic postmenopausal tamoxifen users with a thickened endometrium after 2-3 years of tamoxifen who change to anastrozole. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4093.

Background: Post-colonoscopy colorectal cancers (PCCRCs) pose a challenge in clinical practice. PCCRCs occur due to a combination of procedural and biological causes. Specific features of lesions may contribute for this. In a nested case-control study, we compared clinical and molecular features of PCCRCs and detected CRCs (DCRCs). Methods: PCCRCs were defined according to the WEO 2018 classification, as cancers occurring after a complete index colonoscopy, which excluded CRC. CRCs in patients without colonoscopy or with colonoscopy >10 years before were defined as DCRCs. Whole genome chromosomal copy number changes and mutation status of genes commonly affected in CRC (including APC, KRAS, BRAF, FBXW7, PIK3CA, NRAS, SMAD4 and TP53) were examined by low-coverage WGS and targeted sequencing, respectively. MSI and CIMP status were also determined. Results: In total, 122 PCCRCs and 98 DCRCs with high quality DNA were examined. PCCRCs were more often located proximally in the colon (p<0.001), non-polypoid appearing (p=0.004), early stage (p=0.009), and poorly differentiated (p=0.006). PCCRCs showed similar patterns of DNA copy number changes typical of CRC, although significantly less 18q loss (FDR <0.2), compared to DCRCs. No significant differences in mutations were detected between PCCRCs and DCRCs. PCCRCs were more commonly CIMP-high (p=0.014) and MSI (p=0.029). After correction for tumour location, the only molecular difference between PCCRCs and DCRCs that remained significant was less frequent loss of 18q chromosome in PCCRCs (p=0.005). Conclusion: Although PCCRCs show molecular characteristics that are common to the canonical CIN, MSI and hypermethylation pathways, molecular features associated with the sessile serrated lesions (SSLs) and non-polypoid colorectal neoplasms (CRNs) are more commonly seen in PCCRCs than in DCRCs. This and the clinical features observed in PCCRCs support the hypothesis that sessile serrated lesions and non-polypoid CRNs are contributors to the development of these cancers. In order to further reduce the occurrence of PCCRCs, the focus should be directed at improving the detection, determination and endoscopic removal of these non-polypoid CRN and SSLs. Clinical Trial Registration: NTR3093 in the Dutch trial register (www.trialregister.nl)

Oral communication abstracts10% (11/110) to 82% (37/45); presence of irregular wall ranged from 9% (18/199) to 61% (25/41); proportion of unilocular cysts ranged from 25% (13/51) to 66% (88/134); presence of acoustic shadows ranged from 6% (2/31) to 32% (32/101). Conclusions: Assessments of blood flow at color Doppler ultrasonography and wall irregularity have the highest intercenter variability. OC25.03Ultrasound appearance of cystadenofibroma: can we reduce surgical intervention? S. R. Goldstein, I. Timor-Tritsch, S. Monda, D. Popliolek, A. Monteagudo Ob/Gyn, NYU School of Medicine, New York, NY, USA Objectives: Transvaginal ultrasound has greatly improved our understanding of ovarian neoplasms. Transvaginal ultrasound has had a very high negative predictive value for excluding ovarian malignancy in cases of unilocular cysts and or minimal septations. Solid components and/or mural nodules have been felt to be a more ominous sonographic finding. Cystadenofibromas are benign ovarian neoplasms that originate from the surface epithelium as well as underlying cortical connective tissue of the ovary. Sonographically they often have solid areas that appear to be papillations coming off the cyst wall (''mural nodules'') and thus are almost always surgically removed to exclude malignancy. This study was undertaken to determine if any consistent finding of cystadenofibroma could be discerned thereby increasing the negative predictive value of transvaginal ultrasound and color flow Doppler in identifying them as benign. Material and methods: Over a 6 year period 58 cases of pathologically proven cystadenofibromas were identified from our hospital's pathology database. Of these 32 had transvaginal ultrasound with color flow Doppler performed in our imaging facility. The images were analyzed for size, presence of features beyond simple cystic appearance, and presence or absence of blood flow. Results: 22 of the tumors presented as unilocular cystic structures with one or more solid mural nodules projecting from the cyst wall. None of these displayed any discernable blood flow within the solid area. Ten were multi loculated with multiple solid areas and did not follow this more typical classic appearance. Conclusion: Not all cystadenofribromas will look the same on transvaginal ultrasound and color flow Doppler. The majority(69% in our series) presented as unilocular cysts with a small solid non vascular projection from the cyst wall. This particular presentation was virtually pathognomonic and when present seemed to have reliability for benign cystadenofribroma that approached 100% in this small series. Further study is clearly necessary. Objectives: The aim of this study was to compare volume evaluation in normal and pathological ovaries with two methods: one based on a 3D contour representation of the volume (shell) constructed with VOCAL II software, the other one using three maximum dimensions (x, y, z). Objectives: An existing prediction model may suffer from errors when applied to new data, leading to wrong decisions...