bluuebunny/crossref_metadata_2025 huggingface dataset:
1500 ASSESSMENT OF OSTEOPOROSIS AND FUTURE FRAGILITY FRACTURE RISK IN PATIENTS ADMITTED TO HOSPITAL WITH FALLS
Authors: Eltayeeb M , Mathew P
Published: July 2023

Introduction

NICE guidelines state that assessment of osteoporosis risk is a part of multifactorial fall assessment in older people who present with a fall (NICE clinical guidelines: fall in older people, June 2013). This audit was conducted to examine and improve our practice in assessing osteoporosis risk in patients admitted with fall to Care of Elderly department.

Method

FRAX or QFracture are the recommended tools to evaluate the risk of osteoporosis and future fragility fracture. We have checked if any of these assessment tools has been used in patients who were admitted with a diagnosis of fall.

Results

Baseline data was collected for 30 random patients admitted between 1st January 2022 – 31st March 2022, it showed only in 3.3% the assessment tool (FRAX/QFracture) was used. Following attempts to improve the practice by increasing the awareness of the importance of using FRAX/QFracture tools (lecture presentation and email reminders), a significant improvement has been achieved in cycle 2 which checked 21 random patients between 1st June 2022 and 15th August 2022. This showed 48% of patients have documented risk of osteoporosis and future fragility fracture checked with an assessment tool (FRAX was the tool used in all patients). As a result, osteoporosis treatment was started in 9.8%, DXA scan was requested in 4.8% and only lifestyle advice was given to 33.6% of all fall patients included in cycle 2.

Conclusion

A significant improvement in using the assessment tools (FRAX/Qfracture) in fall patients has been achieved. With continuing to implement the same measures (educating doctors and sending reminders), we are expecting a better result in the future.
1440 IMPROVING COMMUNICATION WITH PATIENTS' RELATIVES ON AN AGING AND COMPLEX MEDICINE (ACM) WARD DURING THE COVID-19 PANDEMIC
Authors: Thompson A , Lim C K , Gibbon F
Published: July 2023

Introduction

During the COVID-19 pandemic, restricted hospital visitation policies were implemented to reduce the spread of the viral infection. As a result, telephone has become the main communication method despite the complexity of the elderly patients’ medical and psychosocial issues. This has heightened anxiety and reduced satisfaction among patients and their families. This quality improvement project aimed at improving communication with patients’ families. We introduced several strategies with the aim to update patients’ families within 48 hours of admission and then at least once a week during patient’s journey from admission to discharge.

Method

Retrospectively, all patients who were admitted to the ACM ward during the study period were included. Multiple Plan-Do-Study-Act (PDSA) cycles were implemented. As the first intervention, we added a new section on “Update patients’ families” in our weekly harm free care document to identify patients’ families who were not updated. Also, reminder emails were sent to all medical doctors to ensure that we record all discussions with families using “Discussions with patients and families’ document”. As the second intervention, a poster on “Harm Free Thursday and Update Friday” was displayed in the doctor’s office. Face-to-face education was provided to new trainees to emphasise the importance of good communication with patients’ families. Data was collected from electronic patient record (EPR) and Microsoft Excel was used for data collection and analysis.

Results

189 patients were included in the baseline audit which showed that only 49% of patients’ families were updated weekly throughout the admission. Compliance in communication with families after the first and second cycle was 62% and 69% respectively. Following the second PDSA cycle, the percentage of patients’ families who were updated within 48 hours of admission increased from 50% to 56%.

Conclusion

The project showed significant improvement in communication with patients’ families with each cycle.
1594 MULTIDISCIPLINARY ADVANCE CARE PLANNING IN CARE HOMES IS ASSOCIATED WITH FEWER AMBULANCE CALL-OUTS AND HOSPITAL CONVEYANCES
Authors: Fraser H , Thorman E , Marchant R , Page E , Allcock D , Worth C , McCracken S , Shipway D
Published: July 2023

Introduction

The Enhanced Health in Care Homes Framework recognises personalised advance care planning (ACP) as a key component of optimal healthcare for care home residents (1). Documented ACP discussions guide decision-making in acute situations and may facilitate avoidance of inappropriate hospital admissions.

Methods

We established a multidisciplinary care home service which aimed to provide comprehensive geriatric assessment (CGA) based ACP to all residents within three pilot care homes. We evaluated the effect of proactive, systematic CGA and ACP. Ambulance call-out and conveyance data for the pilot care homes were compared for three months before and after our intervention.

Results

122 residents were reviewed during the pilot period and 61 new ACPs were completed. Amongst the 61 new ACPs, 41 new decisions were made during the pilot to avoid future hospital admission and to prioritise comfort in the community. Total ambulance callouts to the 3 pilot care homes were observed to fall from 55 to 33 in the 3 months following our intervention: a reduction of 40%. Additionally, when an ambulance attended the scene, conveyance to an acute hospital was observed to fall by 50% (pre-n =40 vs post-n=19), in favour of discharging into the community.

Conclusion

The provision of systematic CGA-based advance care planning in care homes may be associated with a lower frequency of ambulance call-outs and lower rates of conveyance of care home residents to hospital. Proactive advance care planning may influence GP, care home, and paramedic decision-making.

1. NHS England and NHS Improvement. The Framework for Enhanced Health in Care Homes. 2020 Mar.
1668 CAN PROACTIVE, COLLABORATIVE AND CO-PRODUCTIVE ANTICIPATORY CARE PLANS IMPROVE FRAIL HIGH INTENSITY PATIENT OUTCOMES?
Authors: Lowe G , Arora A , Lockett A
Published: July 2023

Background

The High Intensity Users (HIU) Team supports individuals with single or multi-morbidities or complex care needs who are high users of Health and Social Care Services.

Introduction

Stoke-on-Trent has an aged population rising: 65 years plus by 17% increase to 280853; 85 years plus by 38% increase to 39425. Frail older people are the most frequent cohort of patients converted to admissions from ED. From April 2021 to October 2022 there has been an increase of 18% in inpatient length of stay which may be detrimental to the older person. HIU was developed to support this cohort of patients by creating an MDT to create personalised anticipatory care plans.

Methods

Individuals who have had three or more acute admissions and forty days non-elective in-patient days during the previous twelve months were included. An MDT facilitated by a Case Manager formulated an action plan to streamline the care; this includes the Frailty Passport which will identify the advanced/anticipatory care wishes of the individual. This is shared across all relevant teams. Once the actions are complete the patient is then monitored, if stable the patient then has an identified case worker to manage their on-going care.

Results

In the twelve months post consent: ED attendances reduced by 108; Admissions reduced by 477; Length of Stay reduced by 7086 (bed days); Cost saving £2,480,100; Service Cost £400,000; Qualitative feedback 93% patients would recommend; Staff 88% feel there are benefits for patients/services.

Conclusion

The results quite clearly demonstrate the benefits of patient centred care and approach when introducing an anticipatory care plan, including: Raised patient, family and staff satisfaction/ reassurance; Improved access to services; Right care, right time, right professional; Value for money.

Next steps

Useful tool. More studies needed. Expand and share learning with others.
1636 BONE HEALTH ASSESSMENT AUDIT CYCLE AT QUEEN ALEXANDRA HOSPITAL, PORTSMOUTH (AUDIT ID 5474)
Authors: Aperis G , Balaji J , Raheja A
Published: July 2023

Background

Conducted in the department of General Internal Medicine. Our focus group was elderly patients, especially women aged 65 and above and men 75 years and above as per NICE guidelines since these patients should have their bone health assessment done ideally. Local problems: Osteoporosis is very common affecting approximately 3 million people. Over 5,00,000 fragility fracture occurs in UK each year. The purpose of our audit was to find the percentage of patients who underwent bone health assessment and got bone protection treatment appropriately thus checking our compliance to NICE guidelines. Hence keeping in lines with patient safety.

Methods

A total of 45 patient’s data was collected from the medical wards in both the audit and re-audit. Data was collected from patient’s case notes, previous clinical documents and medication charts. A questionnaire was used which entailed patient details, risk factors for osteoporosis and whether or not bone health assessment had been done.

Interventions

We identified patients at risk of osteoporosis. Performed BHA with FRAX score calculation. Started them on appropriate treatment based on NOGG 2021 guidelines. Additionally, a teaching session was held after each audit to implement changes in the department and raise awareness about the importance of bone health assessment. Results: The first audit showed that only 29 out of 45 patients had their assessment done. A total of 41 patients had their assessment done in the re-audit showing a significant improvement by 26%.

Conclusions

Bone health is often overlooked and affects millions of people across the UK with high risk of mortality and morbidity in turn affecting patients’ quality of life. Based on the comparative analysis, 26% more patients benefitted from the completed audit cycle.
1555 AUTOMATED ELECTRONIC HEALTH RECORD FRAILTY ASSESSMENT FOR OLDER CARDIAC PATIENTS
Authors: Ho Z X , Soon R A , Johnston S , MacLullich A M J , Shenkin S D , Mills N L , Anand A
Published: July 2023

Background

Hospital Electronic Health Records (EHRs) increasingly capture health and functional deficits. We report outcomes for acute cardiac patients in relation to an automated frailty measure derived from these EHR data.

Methods

We conducted a retrospective observational cohort study of consecutive cardiology admissions aged ≥70 years between April 2016 and August 2020, to three hospitals across Edinburgh, Scotland. The Continuous Dynamic Evaluation of Frailty (CODE-f) is an automated score between 0 (no markers present) and 1 (all present) representing 12 deficits generated from 31 admission EHR data points. This includes measures of cognition, functional dependence, mobility and falls risk. The primary outcome was mortality at 1 year. The secondary outcome was days alive and out of hospital (‘home time’) in the year after discharge for hospital survivors. In a nested cohort of 318 consecutive patients, the Clinical Frailty Scale (CFS) was determined from manual EHR review blinded to CODE-f scores.

Results

2,406 patients were included (mean 79±6 years old, 60% male). A CODE-f score could be generated in 2,158 (90%) patients, with a median score of 0.13 (IQR 0–0.33). There were 352 (15%) deaths by 1 year. Patients in the highest CODE-f quartile (>0.35) had three times greater risk of death at one year than in the lowest quartile after adjustment for age and sex (27% versus 9%, adjusted odds ratio 3.44, 95% CI 2.47–4.82, p<0.001). 16% of patients from the highest CODE-f quartile lost >90 days home time in the year after discharge, compared to 6% in the lowest two quartiles (p<0.001). CODE-f scores correlated moderately well with CFS (Spearman’s r=0.50, 95% CI 0.41–0.58, p<0.001).

Conclusion

An automated EHR measure can identify older adults at risk of death and poorer recovery after acute cardiac illness. This could inform treatment decisions and future care planning. Funding: Chief Scientist Office (PCL/18/05).
1459 HANDGRIP STRENGTH AS A PREDICTOR OF POST-OPERATIVE OUTCOMES FOLLOWING HIP FRACTURE
Authors: Jaiswal S K , Prowse J , Chaplin A , Sinclair N , Langford S , Reed M , Sayer A A , Witham M D , Sorial A K
Published: July 2023

Introduction

Sarcopenia is common in patients with hip fracture, but few studies have examined whether assessment of sarcopenia improves prediction of adverse post-operative outcomes. We examined whether sarcopenia, diagnosed using hand grip strength (HGS), could predict outcomes after hip fracture.

Methods

Routinely collected data from the National Hip Fracture Database were combined with locally collected HGS data from a high-volume orthopaedic trauma unit. Patients aged ≥65years with surgically managed, non-pathological hip fracture with grip strength measured on admission were included. The European Working Group on Sarcopenia in Older People (EWGSOP2) thresholds were used to identify patients with or without sarcopenia; those unable to complete grip strength testing were also included in analyses. Outcomes examined were 30-day and 120-day mortality, residential status and mobility, prolonged length of stay (>15 days) and post-operative delirium. Binary logistic regression models were used to examine prognostic value of HGS, and discriminant ability for the Nottingham Hip Fracture Score (NHFS) alone and on adding sarcopenia status were compared using c-statistics.

Results

We analysed data from 282 individuals; mean age 83.2 (SD 9.2) years; 200 (70.9%) were female. 99 (35.1%) patients had sarcopenia and 109 (38.7%) were unable to complete testing. Sarcopenia predicted higher 120-day mortality (OR 13.0, 95%CI 1.7-101.1, p=0.014), but not 30-day mortality (OR 1.5, 95%CI 0.1-16.9, p=0.74). Patients unable to complete HGS testing had higher 30-day mortality (OR 13.5, 95%CI 1.8-103.8, p=0.012) and 120-day mortality (OR 34.5, 95%CI 4.6-258.7, p<0.001). Sarcopenia status did not significantly improve discrimination for mobility but improved prediction of 120-day residential status (c-statistic 0.89 [95%CI 0.85-0.94] for NHFS+sarcopenia vs 0.82 [95%CI 0.76-0.87] for NHFS alone) and post-operative delirium (c-statistic 0.91 [95%CI 0.87-0.94] vs 0.78 [95%CI 0.73-0.84]).

Conclusions

Sarcopenia assessment via HGS testing may provide additional prognostic information to existing risk scores in older patients with hip fracture.
1542 IMPLEMENTATION OPPORTUNITIES FOR A GARMENT-INTEGRATED SENSOR SYSTEM FOR EARLY DETECTION OF STRESS IN PEOPLE LIVING WITH DEMENTIA
Authors: Adam E , Meiland F , Frielink N , Meinders E , Smits R , Embregts P , Smaling H
Published: July 2023

Introduction

Stress and communication difficulties, both prone in people with dementia, are risk factors for challenging behaviour. Challenging behaviour negatively impacts the quality of life of people with dementia and their caregivers. Technology can help caregivers detect stress in people with dementia. However, implementation of these technologies is not always successful. The aim of this study is to explore the implementation opportunities for a garment-integrated sensor system that enables caregivers to identify early signs of stress in people with dementia.

Methods

A qualitative design with online focus groups (n=9) and interviews (n=21) with persons living with dementia (n=4), family (n=10) and professional caregivers (n=9) was used to collect stakeholders’ perceptions towards the sensor system and requirements for its implementation into long-term care. Participants took part in three focus groups or interviews, of which the last round focused on implementation. Qualitative data were analysed using inductive conventional content analysis.

Results

Participants were positive about the idea of a garment-integrated sensor system and could see several groups in both intramural and extramural healthcare settings benefit from the system. Besides early stress detection, participants also saw an added value of the system for the identification of triggers for challenging behaviour or for diagnostic purposes. According to participants, implementing the system in long-term care requires clear guidelines and agreements for its use, a trial period and educating caregivers. The sensor system needs to meet several requirements (e.g. customizability, ease of use) to increase user acceptance and thereby implementation success.

Conclusions

Participants perceive the idea of a garment-integrated sensor system for people with dementia in long-term care as positive. To increase implementation success, it is important to create an easy-to-use, tailor-made system, educate stakeholders, and establish clear guidelines for its use. The next step is to validate and implement the system in long-term care.
1625 MELATONIN MODESTLY IMPROVES SLEEP EFFICIENCY IN PATIENTS WITH NEUROCOGNITIVE DISORDERS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Germain N , Rouabhia D , Morin M , Archambault P
Published: July 2023

Introduction

The administration of melatonin and melatonin receptor agonists (MRA) may result in a small improvement in sleep quality among middle-aged and older adults living with neurocognitive disorders, but debate remains as to whether effects are clinically meaningful. The purpose of this PROSPERO-registered systematic review and meta-analysis (CRD42022373972) was to synthesise evidence from randomized controlled trials (RCTs) of melatonin or MRA against placebo and other interventions for the treatment of sleep disturbances in adults with neurocognitive disorders.

Method

CENTRAL, MEDLINE, EMBASE, AMED, CINAHL and PsycINFO were systematically searched on November 4th 2022, examining the effect of melatonin and MRA on sleep efficiency: the percentage of time spent asleep while in bed. Results were analysed using Review Manager 5.4. Risk of bias was assessed using RoB 2 and the certainty of evidence was assessed with the GRADE framework.

Results

Among the 1,579 references evaluated, 13 RCTs were selected, corresponding to 16 studies, none including MRA, with a total of 592 patients. Compared with placebo, bright light treatment, or clonazepam, sleep efficiency significantly improved with melatonin administration (MD = 2.85, 95% CI: 0.88 to 4.81, p = 0.004). In subgroup analyses, only low doses of melatonin (< 5 mg) yielded a statistically significant improvement to sleep efficiency (MD = 3.81, 95% CI: 1.13 to 6.49, p = 0.005, I2 = 34%), and melatonin administration statistically significantly improved sleep efficiency in patients with Mild Cognitive Impairment, Parkinson's Disease, or Multiple Sclerosis (MD = 3.27, 95% CI: 0.11 to 6.43, p = 0.04, I2 = 41%), but not patients with Alzheimer's Disease. We found the overall quality of evidence to be moderate according to GRADE.

Conclusion

Melatonin may modestly ameliorate sleep quality in patients with neurocognitive disorders by improving sleep efficiency, which may be clinically significant to patients and those who care for them.
1447 DELIVERY OF RESISTANCE EXERCISE FOR OLDER PEOPLE LIVING WITH PROBABLE SARCOPENIA OR FRAILTY – FINDINGS FROM THE BEPOP PROJECT
Authors: Caulfield L , Arnold S , Buckland C , de Biase S , Hurst C , Sayer A A , Witham M D
Published: July 2023

Introduction

Resistance exercise is an effective intervention for older people at risk of, or living with, sarcopenia and frailty. Surveys of current UK practice in exercise prescription for these conditions found that resistance exercise was offered in only 9% of departments and was often not optimised for sarcopenia and frailty. The Benchmarking Exercise Programmes for Older People (BEPOP) project is a joint British Geriatrics Society and AGILE initiative to promote best practice in the prescription of resistance exercise for older people.

Methods

Using an online data collection tool, 10 services delivering exercise interventions to older people from across the UK submitted anonymized details of baseline assessment (including demographics), exercise prescription and progression, and outcomes, for up to 20 consecutive patients referred to their services with probable sarcopenia, frailty, falls, and reduced mobility. Descriptive data were reviewed and analysed by an expert panel comprising physiotherapists, geriatricians, and exercise specialists.

Results

Data were analysed for 188 patients with a mean age of 80 years (range 60-101). At the time of referral, 154 (83%) patients did not have a diagnosis of sarcopenia. At baseline, 115 (61%) patients received an objective assessment of muscle strength. The most common modality of resistance exercise prescribed was bodyweight exercises (n=173, 92%) followed by resistance bands (n=49, 26%). Progression of exercise programmes was predominantly through increased repetitions (n=163, 87%) rather than increased load. Forty-one (24%) patients did not undergo any review to inform progression of exercise dose. Fifty patients (30%) patients did not have re-assessment of the outcome measures recorded at baseline on completion of the prescribed exercise programme.

Conclusion

Multiple opportunities exist to improve both the diagnosis and assessment of sarcopenia, and the prescription, delivery, and monitoring of resistance exercise. BEPOP will provide individualized benchmarking reports to each site to facilitate quality improvement and local service development.
1486 RESUSCITATION DISCUSSIONS AND CLINICAL FRAILTY SCALE SCORING IN OLDER ADULTS ADMITTED TO HOSPITAL UNDER GENERAL SURGERY
Authors: Cuesta G , Somoano A , Pressler M , Dewar R , Pardo A , Reinoso P , Fox J , Harris R , Abbott E , Vilches-Moraga A
Published: July 2023

Introduction

Living with frailty is a risk factor for increased short and long term mortality. We aim to describe the uptake of escalation of care and resuscitation status discussions in frail older patients admitted to general, colorectal, and upper gastrointestinal wards.

Methods

Prospective observational study of all patients aged 65 years and over admitted under general surgery 11th February to 11th March 2022 and a second cohort of patients hospitalised between 1st and 31st of October 2022. We scored frailty using the clinical frailty scale (CFS) and identified escalation of care discussions through review of electronic patient records.

Results

We included 196 patients, average age 75.9 (65-97), 90 (46%) females and 106 (54%) males, 107 (54.6%) emergency (EM) and 89 (45.4%) electives (EL). 64 (32.7%) patients were frail (F = CFS ≥5) and 132 (67.3%) non frails (NF = CFS≤ 4). Length of stay was 14 days, 14.9 in F and 11.4 in NF, 14 EM and EL 18.3. Surgery was carried out in 14 (25.9%) F and 33 (40.7%) NF. In total 6 patients died in hospital: 4 F (7.3%) and 3 (3.7%) NF individuals, one without resuscitation decision. Resuscitation discussions had in 20 (36.4%) F vs 4 (4.9%) NF, 19 (16.8%) EM and 6 (6.7%) EL. Percentage of discussions increased in frail patients from 24% to 42.4% overall, and 92% non-frail patients were not offered discussion.

Conclusion

1 in 3 patients in our cohort of older adults hospitalised under surgery were frail. Higher frailty scores were associated with increased in-hospital mortality. 30% frail and 8% non-frail older patients underwent resuscitation discussions. We advocate early proactive discussions of resuscitation status and advance care planning in high-risk surgical patients.
1541 THE IMPACT OF AN AHP PREHABILITATION SERVICE ON FRAILTY FOR CANCER PATIENTS UNDERGOING MAJOR ABDOMINAL SURGERY
Authors: Knowles C , O'Brien R , Ashcroft J , Mansfield A , O’Brien D
Published: July 2023

Background

Prehabilitation in clinical trials improves fitness, improves quality of life, reduces complications, and reduces hospital length of stay It is not standard of care in routine clinical practice. This prospective observational study reports the outcomes of a clinical AHP prehabilitation service for older people undergoing major cancer surgery.

Methods

The LUHFT Prehab service commenced in August 2017, patients prior to major abdominal surgery for cancer were eligible for referral, this was inclusive of 8 different surgical specialties. Referred patients were invited to attend a multi-disciplinary prehabilitation clinic inclusive of physiotherapy, occupational therapy and dietetic support. In a review of the past 12 months clinical frailty score was recorded at baseline and pre surgery. Patients were given individualised exercise, wellbeing, and nutrition plans, and provided with support via 121 or group based follow up. Where distance was a barrier, telephone clinics were undertaken.

Results

Over a 12-month period, 477 patients were referred over the age of 65, of these 436 underwent baseline frailty assessment. Of these 380 went on to have surgery with an average period of 40 days between initial prehab assessment and their elective admission. In these patients 50 scored 5 or above on the clinical frailty scale, 105 fell within the vulnerable category and 163 in managing well at baseline. Of those patients reassessed pre surgery 100% of patients with a frailty score of 5 or above either improved or maintained their score. Of those that scored a frailty score of 4, 94% either improved or maintained their score.

Conclusion

A prehabilitation service is feasible and improves frailty in the lead up to major abdominal elective surgery in a cohort that would otherwise be expected to decondition due to the nature of their disease. Prehabilitation should be part of standard care for older patients undergoing cancer surgery.
Unusual nuclear structures in male meiocytes of wild-type rye as revealed by volume microscopy
Authors: Mursalimov Sergey , Matsumoto Mami , Urakubo Hidetoshi , Deineko Elena , Ohno Nobuhiko
Published: July 2023

Background and Aims

During the analysis of plant male meiocytes coming from destroyed meiocyte columns (united multicellular structures formed by male meiocytes in each anther locule), a considerable amount of information becomes unavailable. Therefore, in this study intact meiocyte columns were studied by volume microscopy in wild-type rye for the most relevant presentation of 3-D structure of rye meiocytes throughout meiosis.

Methods

We used two types of volume light microscopy: confocal laser scanning microscopy and non-confocal bright-field scanning microscopy combined with alcohol and aldehyde fixation, as well as serial block-face scanning electron microscopy.

Key Results

Unusual structures, called nuclear protuberances, were detected. At certain meiotic stages, nuclei formed protuberances that crossed the cell wall through intercellular channels and extended into the cytoplasm of neighbouring cells, while all other aspects of cell structure appeared to be normal. This phenomenon of intercellular nuclear migration (INM) was detected in most meiocytes at leptotene/zygotene. No cases of micronucleus formation or appearance of binucleated meiocytes were noticed. There were instances of direct contact between two nuclei during INM. No influence of fixation or of mechanical impact on the induction of INM was detected.

Conclusions

Intercellular nuclear migration in rye may be a programmed process (a normal part of rye male meiosis) or a tricky artefact that cannot be avoided in any way no matter which approach to meiocyte imaging is used. In both cases, INM seems to be an obligatory phenomenon that has previously been hidden by limitations of common microscopic techniques and by 2-D perception of plant male meiocytes. Intercellular nuclear migration cannot be ignored in any studies involving manipulations of rye anthers.
International Consensus Recommendations on the Aesthetic Usage of Ready-to-Use AbobotulinumtoxinA (Alluzience)
Authors: Ascher Benjamin , Rzany Berthold-Josef , Kestemont Philippe , Redaelli Alessio , Hendrickx Benoit , Iozzo Ivano , Martschin Christoph , Milotich Alicia , Molina Beatriz , Cartier Hugues , Picaut Philippe , Prygova Inna
Published: July 2023

Alluzience (abobotulinumtoxinA RTU; Ipsen, Paris, France and Galderma SA, Lausanne, Switzerland) is the first ready-to-use (RTU) botulinum toxin type A liquid solution approved for the treatment of glabellar lines in Europe. In this article, the authors provide consensus recommendations on the aesthetic usage of abobotulinumtoxinA RTU. Members of the International Board on Alluzience convened to develop consensus on the treatment of glabellar lines as well as other facial wrinkles based on their own extensive experience. Consensus recommendations were developed to provide practical guidelines for injection of abobotulinumtoxinA RTU. General guidance on proper assessment, treatment planning, and patient education is provided, as well as specific injection guidelines per indication. Indications covered include glabellar lines, crow's feet, horizontal forehead lines, lateral eyebrow lift, lower eyelid wrinkles, bunny lines, drooping nasal tip, perioral wrinkles, drooping mouth corners, masseter hypertrophy, hollow cheek lines, dimpled chin, and platysmal bands. These guidelines provide a practical framework to support routine injection of facial muscles with Alluzience.

Level of Evidence: 5
Integrating multiomics and prior knowledge: a study of the Graphnet penalty impact
Authors: Chegraoui Hamza , Guillemot Vincent , Rebei Amine , Gloaguen Arnaud , Grill Jacques , Philippe Cathy , Frouin Vincent
Published: July 2023

Motivation

In the field of oncology, statistical models are used for the discovery of candidate factors that influence the development of the pathology or its outcome. These statistical models can be designed in a multiblock framework to study the relationship between different multiomic data, and variable selection is often achieved by imposing constraints on the model parameters. A priori graph constraints have been used in the literature as a way to improve feature selection in the model, yielding more interpretability. However, it is still unclear how these graphs interact with the models and how they impact the feature selection. Additionally, with the availability of different graphs encoding different information, one can wonder how the choice of the graph meaningfully impacts the results obtained.

Results

We proposed to study the graph penalty impact on a multiblock model. Specifically, we used the SGCCA as the multiblock framework. We studied the effect of the penalty on the model using the TCGA-LGG dataset. Our findings are 3-fold. We showed that the graph penalty increases the number of selected genes from this dataset, while selecting genes already identified in other works as pertinent biomarkers in the pathology. We demonstrated that using different graphs leads to different though consistent results, but that graph density is the main factor influencing the obtained results. Finally, we showed that the graph penalty increases the performance of the survival prediction from the model-derived components and the interpretability of the results.

Availability and implementation

Source code is freely available at https://github.com/neurospin/netSGCCA
An approach for analysing the impact of data integration on complex network diffusion models
Authors: Nevin James , Groth Paul , Lees Michael
Published: July 2023

Complex networks are a powerful way to reason about systems with non-trivial patterns of interaction. The increased attention in this research area is accelerated by the increasing availability of complex network data sets, with data often being reused as secondary data sources. Typically, multiple data sources are combined to create a larger, fuller picture of these complex networks and in doing so scientists have to make sometimes subjective decisions about how these sources should be integrated. These seemingly trivial decisions can sometimes have significant impact on both the resultant integrated networks and any downstream network models executed on them. We highlight the importance of this impact in online social networks and dark networks, two use-cases where data are regularly combined from multiple sources due to challenges in measurement or overlap of networks. We present a method for systematically testing how different, realistic data integration approaches can alter both the networks themselves and network models run on them, as well as an associated Python package (NIDMod) that implements this method. A number of experiments show the effectiveness of our method in identifying the impact of different data integration setups on network diffusion models.
Subcutaneous Infliximab in Refractory Crohn’s Disease Patients: A Possible Biobetter?
Authors: Cerna Karin , Duricova Dana , Lukas Martin , Kolar Martin , Machkova Nadezda , Hruba Veronika , Mitrova Katarina , Kubickova Kristyna , Kostrejova Marta , Jirsa Jakub , Kastylova Kristyna , Peterka Stepan , Vojtechova Gabriela , Lukas Milan
Published: July 2023

Background

A subcutaneous formulation of infliximab (IFX-SC) approved to treat patients with inflammatory bowel disease may offer improved efficacy versus intravenous infliximab.

Methods

Patients with refractory Crohn’s disease (CD, n = 32) previously treated unsuccessfully with at least 2 biologics were treated with IFX-SC and followed from baseline at Week 0 (W0) to Week 30 (W30). The study’s primary endpoint was the treatment’s persistence at W30, while secondary goals included the analysis of serum infliximab trough levels (TL IFX), dynamics of anti-IFX antibodies (ATIs), and clinical, serum and fecal markers of CD activity during IFX-SC treatment.

Results

Midterm treatment persistence with the continuation of treatment after W30 was 53%. TL IFX median values showed rapid, significant upward dynamics and exceeded 15.5 μg/mL at W30, whereas median ATI levels significantly declined. Among ATI-negative patients at W0 (n = 15), only one showed IFX immunogenicity with newly developed ATIs at W30. Among ATI-positive patients at W0, ATI seroconversion from ATI-positive to ATI-negative status was observed in 10 of 17 patients (58.8%). Patients who had continued IFX-SC treatment at W30 showed significant decreases in C-reactive protein (P = .0341), fecal calprotectin (P = .0002), and Harvey–Bradshaw index (P = .0029) since W0.

Conclusions

Patients with refractory CD previously treated with at least 2 biologics exhibited clinically relevant improvement with IFX-SC, which showed less immunogenic potential than IFX-IV and highly stable TL IFX.
Intravascular ultrasound system-guided bail-out stent implantation for iatrogenic aortocoronary dissection: a case report
Authors: Fukui Tomoki , Ogasawara Nobuyuki
Published: July 2023

Background

Iatrogenic aortocoronary dissection (ACD) is a rare but potentially devastating complication of cardiac catheterization. We describe a case of an iatrogenic ACD following catheter engagement and balloon inflation of the proximal right coronary artery (RCA) during an elective percutaneous coronary intervention (PCI).

Case summary

An 81-year-old woman presented with an acute inferior wall ST-elevation myocardial infarction. Emergent coronary angiography revealed the three-vessel diseases. Primary PCI for the culprit lesion of the occluded mid-circumflex artery was successfully performed. After 10 days, an elective PCI for the residual RCA lesions was performed. After the balloon inflation of the proximal RCA, iatrogenic ACD was detected. Intravascular ultrasound-guided stent implantation sealing an entry tear prevented further dissection. The post-operative course was uneventful, and the patient was discharged 1 week later. Follow-up cardiac computed tomography revealed a disappearance of the aortocoronary intramural haematoma.

Discussion

This case emphasizes the importance of prompt detection and intervention for iatrogenic ACD. Heart team discussion is essential to determine whether cardiovascular surgery or percutaneous management should be performed. Bail-out stent implantation sealing an entry tear is frequently used and effective, and an intravascular ultrasound system would help to recognize the morphology of ACD, contributing to the safe procedure.
Great cardiac vein injury after circumflex artery intervention: a case report
Authors: Elhakim Abdelrahman , Elhakim Mohamed , Ismail Ismail , Saad Mohammed
Published: July 2023

Background

Injury of the great cardiac vein (GCV) during circumflex coronary artery intervention is not discussed enough in the literature. In addition, relationship between the GCV and circumflex artery is highly variable and practically unpredictable in 30% of cases. This report describes a rare case of GCV injury during circumflex artery intervention.

Case summary

An 80-year-old man with known ischaemic heart disease was admitted with unstable anginal pain for urgent coronary angiography. Circumflex (Cx) percutaneous coronary intervention (PCI) of proximal-to-medial high-grade calcified stenosis was performed. Two hours later, the patient developed pericardial tamponade. Pericardiocentesis revealed a venous bloody effusion. Due to continuous bleeding, an urgent exploratory thoracotomy was performed. Intraoperatively, a large pericardial haematoma in the Cx region was evacuated. The perforation site was sought and identified as a tear at the GCV. Further hospitalization was uneventful, and the patient was discharged after one week. Clinical and echocardiographic outcomes were favourable at the 3-month follow-up.

Discussion

A GCV injury during PCI is a diagnosis of exclusion if there is a venous pericardial effusion directly after PCI and no injury of the right ventricle or surrounding structures, and thoracic computed tomography demonstrates a pericardial haematoma in the PCI region, especially the Cx region. A haematoma can deteriorate the haemodynamic status without effusion ‘dry tamponade’. Treatment should be addressed according to haemodynamics. A conservative therapy, pericardiocentesis, catheter-based bailout intervention or even an explorative pericardiotomy could be imperative to evacuate the haematoma and seal the injured vein.
Unsuspected diabetic ketoacidosis after myocardial infarction in a patient treated with SGLT2 inhibitor increased length of stay in the hospital: how can it be prevented? A case report
Authors: Oriot Philippe , Hermans Michel P , Beauloye Christophe , Rogghe Pierre-Arnaud , Noel Sophie , Paternotte Emmanuelle
Published: July 2023

Background

As the use of sodium–glucose co-transporter 2 inhibitors (SGLT2is) has expanded beyond glucose-lowering therapy in type 2 diabetes mellitus (T2DM), including chronic kidney disease and heart failure, there has also been an increase in reported cases of diabetic ketoacidosis (DKA) associated with SGLT2i.

Case summary

A 77-year-old woman with T2DM presented to the emergency department with ST-segment elevation myocardial infarction (MI) complicated by atrial fibrillation. Her medications included empagliflozin, an SGLT2i, initiated for T2DM. Diabetic ketoacidosis was suspected on the basis of a large anion gap, despite a plasma glucose level below 200 mg/dL (11.1 mmol/L) and the absence of symptoms, including nausea and vomiting. Laboratory tests confirmed metabolic acidosis and high ketones. However, the diagnosis of euglycaemic DKA (eu-DKA) was delayed due to lack of symptoms and moderate hyperglycaemia. The patient was successfully treated according to DKA management guidelines. She was discharged on insulin, and SGLT2i was discontinued.

Discussion

This is a case of asymptomatic eu-DKA after acute MI (AMI). We discuss the use of SGLT2is in AMI and arrhythmias from a review of the literature and the prophylaxis of eu-DKA. Regular monitoring of blood glucose and ketones should be performed in hospitalized T2DM patients treated with SGLT2i. The SGLT2i should be stopped as soon as possible in the event of critical illness or suspected DKA in the setting of an acute illness such as AMI. To help clinicians prevent this potentially fatal disease, we propose a flowchart for the prophylactic management of eu-DKA among inpatients.
Mismatch of systematic and local inflammatory activity in Takayasu arteritis with coronary involvement: a case report
Authors: Nan Nan , Pan Lili , Dong Ran , Song Xiantao
Published: July 2023

Background

Accurate evaluation of the activity stage in Takayasu arteritis (TA) is important for the revascularization of TA with coronary artery involvement (TA-CAD). Here, we report the case of a patient with a mismatch of systemic and local inflammatory activity, leading to 13 times the need for recurrent coronary revascularization.

Case summary

A 31-year-old woman with a family history of coronary artery disease underwent percutaneous coronary intervention (PCI) for critical ostial lesions. This patient was identified with Numano Type V TA and she underwent optimal medical therapy and PCIs. Her clinical inflammatory markers were quickly normalized. However, in-stent restenosis events recurred every 3 months. Virtual-histology intravascular ultrasound (VH-IVUS) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) confirmed local vascular inflammation. A coronary artery bypass graft (CABG) was also conducted. Before this procedure, both the CABG grafts and the anastomotic areas were accurately assessed with 18FDG-PET/CT. Eventually, this patient remained both angina- and event-free for 2 years post-CABG.

Discussion

The persistence of TA activity despite normal clinical inflammatory markers is uncommon as is the need for recurrent revascularization after appropriate PCI management. Intracoronary imaging and 18FDG-PET/CT play a critical role in assessing TA activity as well as precisely guiding CABG grafts and anastomosis sites to prevent graft failure.
Polypill-based strategy vs. usual care for secondary prevention of cardiovascular disease: a meta-analysis of randomized controlled trials
Authors: Rivera André , Campos Bruno , Ceolin Stephanie , Godoi Amanda , Castanha Everton , Campello Jorge Carlos Alberto , Cardoso Rhanderson
Published: July 2023

Aims

We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the impact of a polypill-based strategy (PBS) on therapeutic adherence and cardiovascular outcomes compared with usual care for secondary prevention of cardiovascular diseases (CVDs).

Methods and results

We systematically searched PubMed, Cochrane, and Scopus databases from inception to January 2023, including RCTs comparing PBS with usual care in patients with prior CVD. We assessed efficacy outcomes of therapeutic adherence, systolic blood pressure (SBP), and LDL-cholesterol (LDL-C) and safety outcomes of all-cause and cardiovascular mortality. Statistical analysis was performed with Review Manager 5.4.1 and R Version 4.2.1. A total of 8 RCTs with a population of 6541 individuals were included, of whom 3318 (50.7%) were treated with the PBS. Follow-up ranged from 6 to 60 months. The polypill-based strategy was associated with a significantly increased therapeutic adherence [risk ratio (RR) 1.22; 95% confidence interval (CI) 1.10–1.34; P < 0.001]. Cardiovascular mortality (RR 0.61; 95% CI 0.44–0.85; P = 0.004), SBP [mean difference (MD) −1.47 mmHg; 95% CI −2.86 to −0.09; P = 0.04], and LDL-C (MD −3.83 mg/dL; 95% CI −6.99 to −0.67; P = 0.02) were significantly lower in the PBS group. The incidence of all-cause mortality was similar between groups (RR 0.83; 95% CI 0.54–1.29; P = 0.41).

Conclusion

In patients with pre-existing CVD, a PBS is associated with lower cardiovascular mortality and improved therapeutic adherence, along with a modest decrease in SBP and LDL-C compared with usual care. Thus, a PBS may be considered a preferred option for this patient population.
The association between type of conception through medically assisted reproduction and childhood cognition: a Danish population-wide cohort study
Authors: Fallesen Peter
Published: July 2023

Background

Previous research has indicated that children conceived through medically assisted reproduction (MAR) generally have cognitive outcomes comparable to or better than naturally conceived children. However, previous studies have been limited in their ability to examine this relationship at a population level and consider variations across different types of MAR.

Methods

This study utilizes data from all live births in Denmark between 2006 and 2009 (n = 259 608), including a subset of births resulting from MAR conceptions (n = 13 566). The dependent variable is the standardized test scores obtained in the second and third grades of primary schools. A comparison is made between the test scores of children spontaneously conceived (SC) and those conceived through intrauterine insemination (IUI) and assisted reproductive technologies (ART). Ordinary least squares regressions are employed, with a baseline model adjusted only for birth year, as well as models that additionally account for conception-related confounders and sociodemographic family characteristics.

Results

In the baseline analysis, ART- and IUI-conceived children displayed better test scores compared with their SC peers. However, after adjusting for relevant factors, ART-conceived children performed worse than SC peers, while IUI-conceived children performed equally well as SC peers and better than ART-conceived children.

Conclusions

These results likely reflect differences in the selection process of potential parents into the type of MAR, as well as the consequences of variations in fecundability. Nevertheless, the differences observed across conception types were overshadowed by test score disparities in socioeconomic background.
Chlamydia trachomatis infection regulates the expression of tetraspanins, activin-A, and inhibin-A in tubal ectopic pregnancy
Authors: Pant Shipra , Bhati Tanu , Dimri Astha , Arora Renu , Siraj Fouzia , Raisuddin Sheikh , Rastogi Sangita
Published: July 2023

Mechanism of Chlamydia trachomatis causing tubal ectopic pregnancy (EP) is not well understood. Tetraspanins (tspans), activin-A, and inhibin-A might play a role in the development of pathological conditions leading to EP. The study aimed to elucidate the expression of tspans, activin-A, and inhibin-A with a role of associated cytokines in C. trachomatis-associated EP and analyze interacting partners of DEGs, with an expression of a few important interacting genes. Fallopian tissue and serum were collected from 100 EP (Group I) and 100 controls (Group II) from SJH, New Delhi, India. Detection of C. trachomatis was done by polymerase chain reaction (PCR) and IgG antibodies were detected by enzyme-linked immunosorbent assay. Expression of tspans, activin-A, inhibin-A, and cytokines was analyzed by real time (RT)-PCR and their interacting genes were assessed by STRING. Expression of few disease-associated interacting genes was studied by RT-PCR. A total of 29% (Group I) were C. trachomatis positive. Tspans and activin-A were significantly upregulated, while inhibin-A was significantly downregulated in Group Ia. ITGA1, TLR-2, ITGB2, and Smad-3 were a few interacting genes. Expression of ITGA1, TLR-2, and Smad-3 was significantly upregulated in C. trachomatis-positive EP. Results suggested dysregulated tspans, activin-A, and inhibin-A might play a role in C. trachomatis-infected tubal EP.