BackgroundCOVID-19-related anxiety, sleep problems, and loneliness may be risk factors for school refusal in children and adolescents. However, few studies have examined the mechanisms by which these risk factors cause school refusal. This study examined the process by which COVID-19-related anxiety, sleep problems, and loneliness cause school refusal, using structural equation modeling.MethodsIn this cross-sectional questionnaire-based study, 256 (109 male, 147 female, mean age: 15.37 ± 0.48 years) senior high school students were asked to complete the Stress and Anxiety associated with Viral Epidemics-6 questionnaire to assess COVID-19-related anxiety, the Athens Insomnia Scale (AIS), Sleep Debt Index (SDI), and chronotype (MSFsc) to assess sleep problems, the Three-Item Loneliness Scale (TILS) to assess loneliness, and Feelings of School-Avoidance Scale (FSAS) to assess school refusal.ResultsStructural equation modeling showed that sleep problems affected loneliness (β = 0.52) and feelings of school refusal (β = 0.37), and that loneliness affected feelings of school refusal (β = 0.47). There was no significant pathway of COVID-19-related anxiety on sleep problems, loneliness, or feelings of school refusal. The indirect effect of sleep problems on feelings of school refusal through loneliness was significant. The results of hierarchical multiple regression analysis showed that AIS (β = 0.30) and SDI (β = 0.13) scores were associated with TILS, and AIS (β = 0.26) and MSFsc (β = −0.14) scores were associated with FSAS scores.ConclusionThe findings of this study showed that sleep problems affected feelings of school refusal via both direct and indirect pathways through the exacerbation of loneliness. To prevent school refusal in adolescents, addressing the indirect pathway via loneliness could be effective in improving insomnia and sleep debt, while addressing the direct pathway could be effective in improving insomnia and chronotype.

1628 Introduction: Standard treatment for localized diffuse large B cell lymphoma (DLBCL) has been rather a short cycle of immunochemotherapy followed by involved field radiotherapy or prolonged cycles of immunochemotherapy. There is no convincing evidence in favor of either strategy. This retrospective analysis is an attempt to compare these treatment options. Methods: Patients were eligible if they had histologicaly newly diagnosed localized DLBCL by the Osaka Lymphoma Study Group (OLSG) central review panel and registered between 2003 and 2011, and received rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) like immunochemotherapy with more than three consecutive courses as initial therapy. In this study, we defined a localized DLBCL as DLBCL with Ann Arbor stage I or non-bulky (<10cm) stage II. One hundred thirty-seven localized DLBCL patients were analyzed retrospectively. Of 137 patients, 83 had 6 to 8 cycles of R-CHOP like immunochemotherapy (Chemo group), and 28 had 3 to 4 cycles of R-CHOP like immunochemotherapy followed by radiotherapy (Chemo+RT group). In this study, the efficacy and tolerability of the 2 treatment groups, Chemo group and Chemo+RT group, in localized DLBCL patients were compared. Treatment outcomes were evaluated, overall survival (OS), progression free survival (PFS) and toxicity were compared according to each treatment option and risk factor. Results: With a median follow-up time of 34 months, neither OS nor PFS differ between these treatment groups. The 3-year OS were 85.5% in Chemo group and 96.2% in Chemo+RT group, respectively (P=0.225). The 3-year PFS were 74.3% in Chemo group and 89.7% in Chemo+RT group, respectively (P=0.185). A multivariate Cox regression model showed that Chemo+RT group have a tendency to improve PFS [hazard ratio =0.33; 95% confidence interval 0.10–1.07; P =0.066] of localized DLBCL compared with Chemo group. Grade 3 to 4 neutropenia and neutopenic fever were more frequent in patients with Chemo group (P<0.01, P<0.01, respectively). Conclusion: For the treatment of localized DLBCL, although the difference between two treatment options was not significant in efficacy, short cycle of immunochemotherapy followed by radiation therapy seems to be superior to prolonged cycles of immunochemotherapy in terms of safety. Further studies are needed to define the optimal treatment option for localized DLBCL in the rituximab era. Disclosures: No relevant conflicts of interest to declare.

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Sixteen cases of 11 laryngeal and 5 hypopharyngeal cancers required emergency tracheostomy were reviewed. The incidence requiring the emergency tracheostomy of the hypopharyngeal cancer (11.4%) was high about two times compared to that of the laryngeal cancer (6.3%). Sex incidence was 13 males and 3 females and average age was 70.5 years old in the laryngeal cancer and 55.8 years old in the hypopharyngeal cancer. The glottic carcinoma and the piriform sinus carcinoma were most frequently found in the larynx and the hypopharynx respectively. All cases were classified in T3 or T4. Lymph node metastasis was observed in all cases of the hypopharyngeal cancer but in some cases of the laryngeal cancer. A case of lung metastasis in the hypopharyngeal cancer was precisely reported. Various factors influencing late diagnosis were pointed out and discussed. Subglottic extension of glottic carcinoma should be determined exactly. An appeal to the other division's doctor for knowledge and recognition of the head and neck cancer was emphasized to make early diagnosis.

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