Dermoscopy of Inflammatory Dermatoses (Inflammoscopy) in Skin of Color - A Systematic Review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force

Dermoscopic patterns of inflammatory dermatoses (inflammoscopy) have been extensively studied in the recent years, though data on patients with darker phototypes (IV-VI) are sparse. The aims of this systematic review were to summarize the current state of knowledge on inflammoscopy applied to skin of color and provide a standardized nomenclature of reported findings. Besides dermoscopic features, type of setting and magnification, number of cases, and histopathological correlation were analyzed. Eighty-five papers addressing 78 different dermatoses (25 papulosquamous dermatoses, 19 hyperpigmented dermatoses, eight hypopigmented dermatoses, four granulomatous dermatoses, two sclerotic dermatoses, five facial inflammatory dermatoses, and 15 miscellaneous conditions) for a total of 2073 instances were retrieved. Only one study showed a level of evidence of III (cross-sectional study), whereas 10 and 74 displayed a level of evidence of IV (case-control studies) and V (case-series and case-reports), respectively. Moreover, our analysis also highlighted that most of papers focalized on a limited number of dermatoses, with several conditions having only single dermoscopic descriptions. Additionally, few studies compared findings among phototypes belonging to the "skin of color" spectrum. Further studies designed according to a systematic approach and considering the above-mentioned issues are therefore needed.

Dermoscopy of Infectious Dermatoses (Infectiouscopy) in Skin of Color - A Systematic Review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force

Dermoscopy has been showed to facilitate the non-invasive recognition of several infectious disorders (infectiouscopy) thanks to the detection of peculiar clues. Although most of the knowledge on this topic comes from studies involving light-skinned patients, there is growing evidence about its use also in dark phototypes. This systematic literature review summarizes published data on dermoscopy of parasitic, bacterial, viral and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 66 papers addressing 41 different dermatoses (14 bacterial, 5 viral, 11 fungal infections, and 11 parasitoses/bites and stings) and involving a total of 1096 instances were included in the analysis. The majority of them displayed a level of evidence of V (44 single case reports and 21 case series), with only 1 study showing a level of evidence of IV (case-control analysis). Moreover, our analysis also highlighted a high variability in the terminology used in the retrieved studies. Thus, although promising, further studies designed according to a systematic and standardized approach are needed for better characterization of dermoscopy of infectious skin infections.

Virtually Delivered Psychosocial Intervention for Prenatally Diagnosed Congenital Heart Disease: Feasibility and Acceptability of HEARTPrep

Prenatal diagnosis of congenital heart disease (CHD) often leads to anxiety, depression, and traumatic stress in expectant mothers, with long-term implications for the child and family. However, psychosocial intervention is rarely incorporated into prenatal care. HEARTPrep is a virtually delivered psychosocial intervention aimed at reducing distress and social isolation and increasing parenting self-efficacy and hope for mothers expecting a baby with CHD to promote long-term child/family well-being. This study evaluated the feasibility and acceptability of HEARTPrep. Participants were mothers receiving cardiology care for a fetal CHD diagnosis. Partners could participate with the mother. HEARTPrep was delivered through a mobile app and telehealth. Feasibility was assessed through enrollment/retention rates. Acceptability was assessed through 20 Likert-scale and five open-ended questions. Of 39 recruited mothers, 35 (90%) enrolled. Half of partners (48%) also participated. Twenty-seven of 35 enrolled mothers (77%) completed HEARTPrep. On a scale from 0 (Not at All) to 4 (Very), mean item acceptability scores ranged from 3.5 to 3.9. Mothers reported HEARTPrep helped them feel less distressed (mean: 3.74), less alone (3.84), more prepared (3.89), and more hopeful (3.84). Opportunities to process emotions, develop coping skills, learn with their partner, navigate relationships, understand they are not alone, connect with peer support, access resources, and prepare for stressors were described as helpful. HEARTPrep is feasible and acceptable for mothers expecting a baby with CHD. Future research will evaluate its efficacy in preventing/reducing maternal mental health problems and improving postnatal clinical outcomes.

Dermoscopy of Cutaneous Neoplasms in Skin of Color - A Systematic review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force

Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes from studies on light photo-types. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assessment even for skin of color. This systematic literature review evaluated published data in dark-skinned patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies), also providing a standardized and homogeneous terminology for reported dermoscopic findings. A total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of them showed a level of evidence of V (12 single case reports and six case series), with only two studies featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined that some neoplasms and phototypes are underrepresented in published analyses as they included only small samples and mainly certain tones of "dark skin" spectrum (especially phototype IV). Therefore, further studies considering such limitations are required for a better characterization.

[Polypharmacy and medication review in the context of prehabilitation]

Against the background of typical geriatric multimorbidity and with the particular vulnerability of geriatric patients, polypharmacy deserves special attention. In accordance with the guidelines, medication should not only be reviewed regularly, but also on an ad hoc basis and with each hospital stay-and also in the context of prehabilitation. Thus, not only substances that interfere with the currently planned intervention, anesthesia, or risk of bleeding should be considered, but any medication that increases common risks for geriatric patients. These include drugs that cause or increase a tendency to fall, induce delirium, or alter the comedication through potential drug-drug interactions. Measures to minimize the risk include the following: exact documentation of medications, structured and complete transfer of information, patient and family training about any side effects that may occur, a recall system for possible laboratory checks, and compliance with the instructions for taking the medication.

Dermoscopy of Hair and Scalp Disorders (Trichoscopy) in Skin of Color - A Systematic Review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force

Hair and scalp disorders are of significant interest for physicians dealing with dark phototypes due to their prevalence and potential aesthetic impact resulting from a higher tendency for scarring. In order to facilitate their non-invasive diagnosis, several dermoscopic studies have been published, yet data are sparse and no systematic analysis of the literature has been performed so far. This systematic literature review summarizes published data on trichoscopy of hair and scalp diseases (trichoscopic findings, used setting, pathological correlation, and level of evidence of studies). A total of 60 papers addressing 19 different disorders (eight non-cicatricial alopecias, nine cicatricial alopecias, and two hair shaft disorders) were assessed, for a total of 2636 instances. They included one cross-sectional analysis, 20 case-control studies, 25 case-series, and 14 single case-reports, so the level of evidence was V and IV in 65% and 33% of cases, respectively, with only one study showing a level of evidence of III. Notably, although there is a considerable body of literature on trichoscopy of hair/scalp diseases, our review underlined that potentially significant variables (e.g., disease stage or hair texture) are often not taken into account in published analyses, with possible biases on trichoscopic patterns, especially when it comes to hair shaft changes. Further analyses considering all such issues are therefore needed.

Cerebral revascularization surgery reduces cerebrovascular events in children with sickle cell disease and moyamoya syndrome: Results of the stroke in sickle cell revascularization surgery retrospective study

BACKGROUND

Recent studies suggest that cerebral revascularization surgery may be a safe and effective therapy to reduce stroke risk in patients with sickle cell disease and moyamoya syndrome (SCD-MMS).

METHODS

We performed a multicenter, retrospective study of children with SCD-MMS treated with conservative management alone (conservative group)-chronic blood transfusion and/or hydroxyurea-versus conservative management plus surgical revascularization (surgery group). We monitored cerebrovascular event (CVE) rates-a composite of strokes and transient ischemic attacks. Multivariable logistic regression was used to compare CVE occurrence and multivariable Poisson regression was used to compare incidence rates between groups. Covariates in multivariable models included age at treatment start, age at moyamoya diagnosis, antiplatelet use, CVE history, and the risk period length.

RESULTS

We identified 141 patients with SCD-MMS, 78 (55.3%) in the surgery group and 63 (44.7%) in the conservative group. Compared with the conservative group, preoperatively the surgery group had a younger age at moyamoya diagnosis, worse baseline modified Rankin scale scores, and increased prevalence of CVEs. Despite more severe pretreatment disease, the surgery group had reduced odds of new CVEs after surgery (odds ratio = 0.27, 95% confidence interval [CI] = 0.08-0.94, p = .040). Furthermore, comparing surgery group patients during presurgical versus postsurgical periods, CVEs odds were significantly reduced after surgery (odds ratio = 0.22, 95% CI = 0.08-0.58, p = .002).

CONCLUSIONS

When added to conservative management, cerebral revascularization surgery appears to reduce the risk of CVEs in patients with SCD-MMS. A prospective study will be needed to validate these findings.

International Dermoscopy Society (IDS) Criteria for Skin Tumors: Validation for Skin of Color Through a Delphi Expert Consensus by the "Imaging in Skin of Color" IDS Task Force

INTRODUCTION

A structured set of eight basic dermoscopic parameters (lines, clods, dots, circles, pseudopods, structureless, else, and vessels) including a total of 77 variables with corresponding descriptive and metaphoric vocabulary has been released for evaluation of skin tumors by the International Dermoscopy Society (IDS).

OBJECTIVES

To validate the aforementioned criteria for the use in darker phototypes (phototypes IV-VI) via an expert consensus.

METHODS

The two-round "Delphi method" was adopted, with an iterative process including two rounds of email questionnaires. Potential panelists were asked to take part in the procedure via email on the basis of their expertise in the dermoscopy of skin tumors in dark phototypes.

RESULTS

A total of 17 participants were involved. All the original variables of the eight basic parameters reached agreement during the first round, except for "pink small clods" ("milky red globules") and "structureless pink zone" ("milky red areas"). Moreover, during the first round, panelists proposed a change of three existing items and the introduction of four new items, i.e., "black, small clods" ("black globules"), "follicular plugs", "erosions/ulcerations", and "white color around vessels" ("perivascular white halo"). All such proposals achieved agreement, thus being included in the final list, for a total of 79 items. There was consistency between the descriptive and metaphoric approaches in terms of scoring.

CONCLUSIONS

Albeit most of the original items were considered applicable even for skin of color, there are some points of differences that physicians need to know. No significant preference was found between descriptive and metaphoric terminology among panelists.

Mental Health in Individuals with a History of Mental Disorder during COVID-19-Pandemic - Preliminary Results of the National Cohort Study in Germany

Introduction

Research of COVID-19-Pandemic mental health impact focus on three groups: the general population, (2) so called vulnerable groups (e.g. individuals with mental disorders) and (3) individuals suffering COVID-19 including Long-COVID syndromes.

Objectives

We investigate whether individuals with a history of depression in the past, react to the COVID-19 pandemic with increased depressive symptoms.

Methods

Longitudinal Data stem from the NAKO-Baseline-Assessment (2014-2019, 18 study centers in Germany, representative sampled individuals from 20 to 74 years) and the subsequent NAKO-COVID-Assessment (5-11/2020). The sample for analysis comprises 115.519 individuals. History of psychiatric disorder was operationalized as lifetime self-report for physician-diagnosed depression. Depressive symptoms were measured with the PHQ 9.

Results

Mean age of the sample at baseline was 49.95 (SD 12.53). It comprised 51.70 women; 14 % of the individuals had a history of physician-diagnosed depression. Considering a PHQ-Score with cut-off 10 as a clinical relevant depression, 3.65 % of the individuals without history of depression and 24.19 % of those with a history of depression were depressed at baseline. The NAKO-COVID-Assessment revealed 6.53 % depressed individuals without any history of depression and a similar rate of 23.29 % in those with history of depression.

Conclusions

In contrast to that what we expected, individuals with a history of a physician-diagnosed depression, did not react with increasing depressiveness during the first phase of the pandemic in Germany. Several reasons could be discussed. Whether there medium and long-term impact remains open.

Disclosure

No significant relationships.

The value of diastolic speckle-tracking parameters in predicting outcome after surgical ventricular restoration

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): DZHK (German Centre for Cardiovascular Research) BMBF (German Ministry of Education and Research)

Background. Parameters of speckle-tracking echocardiography (STE) are incorporated into the integrative assessment of left ventricular (LV) diastolic function 1. In this study we aimed to evaluate both established and novel STE parameters of LV diastolic function and their prognostic role in patients with LV anteroapical aneurysm planned for surgical ventricular restoration (SVR).

Methods. We retrospectively examined data of 137 patients (60 ± 11 years, 25% women) with anteroapical LV aneurysm who underwent SVR and for whom preoperative echocardiography was available and feasible for STE and for conventional assessment of LV diastolic function by transmitral flow. STE parameters evaluated were: left atrial reservoir strain (LAS), early and late global diastolic strain rate (GLSRe and GLSRa), ratio of early-to-late diastolic strain rate (GLSRe/GLSRa), and ratio of early diastolic transmitral flow velocity (E) to GLSRe and to GLSRa. In 24 patients we evaluated an association of diastolic echocardiographic parameters with mean pulmonary artery pressure (PAPm) and mean pulmonary capillary wedge pressure (PCWPm) obtained invasively within 6 days of echocardiography. Preoperative echocardiographic parameters were assessed in whole cohort of patients for the association with an outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation.

Results. During a median follow-up of 4.7 years (IQR: 1.4-8.1 years) events occurred in 59 patients. GLSRa, E/GLSRa and LAS demonstrated significant correlation with PAPm and PCWPm (Table 1). GLSRa with optimal cut-off value of ≤ 0.41 s-1 was able to detect PAPm >30 mmHg with sensitivity of 0.8 and specificity of 0.8 (AUC 0.85; 95% CI 0.68-1.0; p = 0.008). E/GLSRa ≥1.24 m was able to detect PAPm >30 mmHg with sensitivity of 1.0 and specificity of 0.8 (AUC 0.87; 95%CI 0.7-1.0; p = 0.005). There was significant difference in event-free survival between groups stratified by cut-offs for GLSRa (Fig. 1A) and E/GLSRa (Fig. 1B). After adjustment for important clinical (age, sex, plasma creatinine, atrial fibrillation) and echocardiographic parameters (fractional shortening and LV end-systolic volume index) GLSRa and E/GLSRa remained an independent predictors of events (HR 0.16; 95% CI: 0.03-0.86; p = 0.032 and HR 1.22; 95% CI: 1.03-1.43; p = 0.018) and demonstrated higher prognostic value compared to LAS, other STE parameters and conventional parameters of LV diastolic function.

Conclusion. Late diastolic longitudinal strain rate and ratio of early diastolic transmitral flow velocity to late diastolic longitudinal strain rate demonstrated association with hemodynamic parameters in patients with LV anteropaical aneurysm and might be used for the evaluation of LV diastolic function. These parameters showed prognostic value for patients underwent SVR and could be implemented for preoperative evaluation of these patients. Abstract Table 1. Correlation data  Abstract Figure 1. Survival curves

[Comparison of catheter-associated quality of life in external urinary diversion: nephrostomy vs. suprapubic catheter]

Einleitung

Die katheterbezogene Lebensqualität (LQ) bei Nephrostomieträgern wurde bisher noch nie systematisch untersucht. Dies sollte nun erstmalig vergleichend mit einer ebenfalls externen Urinableitung, dem suprapubischen Katheter, geschehen.

Methodik

Das die katheterbezogene LQ untersuchende Assessment nach Mary Wilde wurde bei Patienten mit perkutaner Nephrostomie (PCN) in lebenslanger Intention und minimaler Liegedauer von 3 Monaten vorgelegt.

Ergebnisse

Es zeigte sich insgesamt bei 66 Patienten (davon 42 mit unilateraler PCN) mit einem Punktwert von median 4,0 auf einer Skala von 0–5 eine nur moderat eingeschränkte katheterbezogene LQ. Diese wurde insgesamt und in allen Domänen schlechter als bei Patienten mit suprapubischem Katheter (SPK) bewertet, bei denen sich ein Score von 4,3 im Median fand. Signifikant waren die Unterschiede in den Einzelitems „Gefühl der Erniedrigung“, „Konflikte mit ärztlichem oder pflegerischem Personal“, „Angst vor schmerzhaften Katheterwechseln“, „Gefühl als kranke Person“, „Behinderungen in Aktivitäten des täglichen Lebens“ und „Besorgnis, nicht alles tun zu können, was ich mag“. Ebenso ergaben sich bei PCN-Trägern signifikant häufiger Angst vor Katheterlecks und Uringeruch. Die Anzahl der einliegenden PCN und die Grunderkrankung spielten für die Beurteilung der LQ keine Rolle.

Schlussfolgerung

Erstmals wurde die katheterassoziierte LQ, die sich bei PCN-Trägern nur moderat eingeschränkt fand, mit einem validierten Assessment quantitativ eingeordnet. Die Angabe der Betroffenen, sich als „krank“ und in der Ausübung von Aktivitäten des täglichen Lebens „behindert“ zu fühlen und die Angst vor Urinleckagen und schmerzhaften Wechseln sollten Ansporn für eine sorgfältige Indikationsstellung und technisch korrekte Katheterwechsel sein.

[Guidelines for consultations regarding incontinence care products]

An investigation of the German consumer organisation "Stiftung Warentest" in 2017 confirmed significant deficiencies in the information, advice and supply of incontinence care products received by urinary incontinence patients. The German Society of Urology (DGU) thereupon drafted and later published guidelines concerning the consultation of patients in the context of incontinence care. Important aspects of the consultation process include the determination of the type of incontinence as well as its severity, clinical examination, and advice regarding possible curative treatments. However, the advice appointment takes centre stage and should ideally be conducted by a qualified person in a separate room granting sufficient privacy and time. Furthermore, repeated supply of a selection of samples for differing degrees and types of incontinence, accommodating the patient's individual preferences and anatomical features, is crucial in order to ensure optimal incontinence care. In the case of commercial health care service providers, transparency relating to the financial implications of e.g. expensive products is key, which is what has been intended by German health insurance providers. The new guidelines concerning urinary incontinence care consultation constitute a step towards the improvement and structuring of processes in the consultation regarding, and the supply of, incontinence care products.

[Quality of life for wearers of a suprapubic or transurethral bladder catheter as lifelong permanent care]

Hintergrund

Die Anlage eines transurethralen Dauerkatheters (DK) oder suprapubischen Harnblasenkatheters (SPK) in lebenslanger Indikation stellt einen Eingriff mit relevanten Komplikationen, Komorbiditäten und möglichen Auswirkungen auf die katheterassoziierte Lebensqualität des Betroffenen dar. Letztere wurde aber bisher noch nicht untersucht.

Methodik

Zur Anwendung kam ein validiertes Assessment zur katheterbezogenen Lebensqualität mit 25 Items in 5 Domänen. Befragt wurden im Rahmen eines Katheterwechsels Patienten mit einem DK oder SPK in lebenslanger Intention, die diesen mindestens 3 Monate trugen.

Ergebnisse

Fragebögen von 357 Patienten, davon 260 Männer und 97 Frauen, 193 mit SPK und 162 mit DK (2 ohne Angabe) lagen vor. Patienten mit DK waren mit 78,9 ± 11,1 Jahren signifikant älter als solche mit SPK mit 74,4 ± 12,6 Jahren (p < 0,001). Der mittlere Gesamtlebensqualitätsscore lag bei 4,1 ± 0,9 Punkten auf einer Skala von 1 (maximal beeinträchtigte Lebensqualität) bis 5 (keine Beeinträchtigung der Lebensqualität). Es zeigten sich u. a. mit niedrigeren Scores eine vermehrte Angst vor Katheterlecks, Angst vor Uringeruch und Harnwegsinfektionen und vor schmerzhaften Katheterwechseln. Diese Sorgen waren v. a. bei Frauen, solchen mit Harninkontinenz, Trägern eines Katheters ≥ 18 Ch und bei Patienten < 70 Jahren vorhanden. Frauen mit einem SPK wiesen eine schlechtere Bewertung ihrer Lebensqualität als Männer mit SPK auf.

Schlussfolgerung

Die gefundenen Ergebnisse sollten in die Aufklärung zu einer lebenslangen Katheterableitung einfließen bzw. im Kontext möglicher Alternativen wie z. B. einer operativen Desobstruktion oder einer Hilfsmittelversorgung mit dem Patienten bzw. Betreuungspersonen besprochen werden.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00120-021-01642-1) enthält weitere Tabellen mit detaillierten Ergebnissen der Fragen der 5 abgefragten Domänen.

Combined Arrhenius-Merz Law Describing Domain Relaxation in Type-II Multiferroics

Electric fields were applied to multiferroic TbMnO_{3} single crystals to control the chiral domains, and the domain relaxation was studied over 8 decades in time by means of polarized neutron scattering. A surprisingly simple combination of an activation law and the Merz law describes the relaxation times in a wide range of electric field and temperature with just two parameters, an activation-field constant and a characteristic time representing the fastest possible inversion. Over the large part of field and temperature values corresponding to almost 6 orders of magnitude in time, multiferroic domain inversion is thus dominated by a single process, the domain wall motion. Only when approaching the multiferroic transition other mechanisms yield an accelerated inversion.

P–485 A systematic analysis of acupuncture for IVF treatment: how should the HFEA traffic light scale for add-ons rate it?

Study question

How should acupuncture be rated on the Human Fertilisation and Embryology Authority traffic light scheme for IVF add-ons?

Summary answer

Randomised controlled trials examining the possible effects of acupuncture on IVF success rates are conflicting, and acupuncture should be rated amber.

What is known already

The use of complementary therapies in assisted reproduction and IVF has become increasingly more commonplace in recent years. Patients seeking to maximise their chances of conception are often interested in purchasing additional treatments (termed ‘add-ons’) to augment their treatment cycle, often at a high price even in the absence of robust underlying evidence. The use of acupuncture is popular due to putative holistic benefits including stress reduction, and the perceived lack of side-effects and minimal invasiveness. The HFEA traffic light system has not yet rated any complementary therapies, even though these are promoted by fertility clinics.

Study design, size, duration

A systematic review of randomised controlled trials (RCTs) of acupuncture during IVF treatment was conducted. A literature search for acupuncture studies was conducted on the PubMed database and the University College London (UCL) library database. Search terms used were “acupuncture” paired with “IVF”, “in vitro fertilisation”, “assisted reproduction” and “RCT”. Study quality and variance in treatment protocols were assessed, to understand both any evidence and its quality. Statistical analysis was performed using STATA.

Participants/materials, setting, methods

The UCL library database yielded 403 individual search results and PubMed database yielded 47. Papers were screened and sorted according to the inclusion and exclusion criteria. Inclusion: publication in English, in an English-language journal; RCT; intervention administered during IVF; either pregnancy rate (PR), ongoing/clinical PR or live birth rate (LBR) reported. Exclusion: reviews; not in English; not RCT; above outcomes not reported.

Main results and the role of chance

After final screening, a total of 34 acupuncture RCTs were included in the review and meta-analysis. The sample sizes of the studies analysed ranged from 44 to 809 (median 162). Only a minority of studies (18%, 6/34) involved blinding of both assessor and participant, while foregoing incorporation of blinding into study design was most common (44%, 15/34 studies). There was little consistency regarding the timing of acupuncture treatment during the IVF protocol across RCTs. A total of 21/34 studies (62%) had a protocol involving acupuncture administration before and after the embryo transfer procedure on the day of transfer. The number of needle insertions during the treatment protocols ranged from 5–13 (mean 8.7). Manual acupuncture only was performed in 8/34 (24%) of studies and 26/34 (76%) utilised electrical stimulation of at least some of the acupuncture needles. Out of 34 RCTs, only 10/34 studies (29%) reported LBR. The meta-analysis included all identified RCTs. The most clinically relevant outcome measure reported in each study found a slight benefit of acupuncture for overall IVF success (OR 1.37, 95% CI 1.13–1.65) however the effect was diluted when only comparing studies reporting LBR (OR 1.14 ,95% CI 0.81–1.61).

Limitations, reasons for caution

Methodological heterogeneity of acupuncture RCTs in IVF (needling location, stimulation, retention time, repetition and timing) complicates data pooling. Underlying neurophysiological mechanisms of action are still being clarified and may help delineate optimal regimens, potentially tailored to individual causes of infertility. Treatment safety and potential for worse outcomes must be considered.

Wider implications of the findings: Complementary therapies are a popular add-on for IVF treatment but assessing them from a robust biomedical perspective is challenging due to issues with study design (including controls), study quality and general attitudes. For acupuncture, future research should arguably focus on biomedical perspectives and shift away from Traditional Chinese Medicine philosophies.

Trial registration number

Not applicable

Grief and loss in old age: Exploration of the association between grief and depression

BACKGROUND

The proportion of older adults is increasing due to demographic changes. Depression belongs to the most common mental disorders in late life. The loss of an emotionally significant person is a risk factor for the development of depression. The aim of this study is to analyze the association between depression and grief burden resulting from loss. Based on prior evidence, we examined loneliness as a possible mediator and social support as possible moderator of this association.

METHODS

The cross-sectional analyses are based on a sample (N = 863) of study participants aged 75+ (M = 81.4 years, SD = 4.4, 62.2% female) with loss experience deriving from the multicenter prospective German cohort study AgeMooDe. Regression analyses (moderated mediation) were performed.

RESULTS

With increasing age (β = 0.10, p = .005) and grief burden (β = 0.33, p <. 001) depression severity increased. There was an indirect mediating effect of loneliness on the correlation of grief burden and depression (b = 0.04, CI [0.03, 0.05]), but no moderating effect of social support on the correlation of grief burden and loneliness. People living alone had a significantly higher risk of depression, increased loneliness and lack of social support.

LIMITATIONS

Assessments were based on self-reporting and recorded dimensionally. The cross-sectional design limits conclusions about directions and causality of associations. Sampling bias cannot be completely excluded.

CONCLUSION

The study provides empirical evidence and a better understanding of the association between grief and depression among the very old and the mediating role of loneliness.

Exposure to bisphenol A differentially impacts neurodevelopment and behavior in Drosophila melanogaster from distinct genetic backgrounds

Bisphenol A (BPA) is a ubiquitous environmental chemical that has been linked to behavioral differences in children and shown to impact critical neurodevelopmental processes in animal models. Though data is emerging, we still have an incomplete picture of how BPA disrupts neurodevelopment; in particular, how its impacts may vary across different genetic backgrounds. Given the genetic tractability of Drosophila melanogaster, they present a valuable model to address this question. Fruit flies are increasingly being used for assessment of neurotoxicants because of their relatively simple brain structure and variety of measurable behaviors. Here we investigated the neurodevelopmental impacts of BPA across two genetic strains of Drosophila-w¹¹¹⁸ (control) and the Fragile X Syndrome (FXS) model-by examining both behavioral and neuronal phenotypes. We show that BPA induces hyperactivity in larvae, increases repetitive grooming behavior in adults, reduces courtship behavior, impairs axon guidance in the mushroom body, and disrupts neural stem cell development in the w¹¹¹⁸ genetic strain. Remarkably, for every behavioral and neuronal phenotype examined, the impact of BPA in FXS flies was either insignificant or contrasted with the phenotypes observed in the w¹¹¹⁸ strain. This data indicates that the neurodevelopmental impacts of BPA can vary widely depending on genetic background and suggests BPA may elicit a gene-environment interaction with Drosophila fragile X mental retardation 1 (dFmr1)-the ortholog of human FMR1, which causes Fragile X Syndrome and is associated with autism spectrum disorder.

Prognostic role of left ventricular diastolic function assessed by speckle tracking echocardiography in patients after surgical ventricular repair

Background

Assessment of left ventricular (LV) diastolic function brings important prognostic information for patients with heart failure and could be evaluated by speckle tracking echocardiography (STE). Less known about its role in patients planned for surgical ventricular repair due to LV aneurysm.

Purpose

The aim of this study was to evaluate the prognostic role of STE parameters of LV diastolic function for prediction of all-cause mortality in patients after surgical ventricular repair.

Methods

We retrospectively evaluated data of 163 consecutive pts (mean age 62.3±11.5 years, 74.8% males) with anteroapical LV aneurysm who underwent surgical ventricular repair combined with coronary artery bypass surgery (71.8%) Prognostic role for prediction of all-cause mortality was assessed for various STE parameters, including left atrial strain (LAS) measured as peak reservoir strain and for the ratio of early to late global longitudinal strain rate (GLSRe/GLSRa).

Results

During a median follow-up of 4.7 years (IQR: 1.6–8.9 years) there were 65 deaths, 5 year survival rate was 73.8 (95% CI 67–79%). Baseline ejection fraction, end-diastolic and end-systolic volumes of LV did not differ between pts who died and survived at 5 year after the surgery, whereas LAS was significantly higher and GLSRe/GLSRa was significantly lower in survivors. Cox proportional hazard model adjusted to demographic and clinical variables demonstrated that LAS and GLSRe/GLSRa were independent predictors of all-cause death, with HR of 0.79 (95% CI 0.66–0.95, p=0.012) for each 5% increase of LAS and HR of 1.24 (95% CI 1.1–1.4, p=0.001) for each 0.5 increase of GLSRe/GLSRa. Moreover, GLSRe/GLSRa remained an independent predictor after additional adjustment for LV end-systolic volume, sphericity index and presence of mitral insufficiency of grade 2 and higher. A significant difference in median survival time was demonstrated according to the following cut-offs: LAS ≥16.7% (12.1 vs. 6.4 years, p=0.01), GLSRe/GLSRa ratio ≥2.3 (3.3 years vs. 10.2 years, p=0.0005) (Figure). The classification and regression tree analysis with the application of all two-dimensional, Doppler and various speckle-tracking echocardiographic parameters revealed that GLSRe/GLSRa and LAS were the most important echocardiographic variables for risk stratification for 5-year mortality.

Conclusion

This study demonstrates that STE parameters of LV diastolic function are important predictors of all-cause mortality after surgical ventricular repair due to anteroapical aneurysm of LV and could be used in the preoperative decision-making process.

Funding Acknowledgement

Type of funding source: None

Inflammation, but Not the Underlying Disease or Its Location, Predicts Oral Iron Absorption Capacity in Patients With Inflammatory Bowel Disease

BACKGROUND AND AIMS

Anaemia is common in patients with inflammatory bowel disease [IBD], its two main aetiologies being iron deficiency anaemia [IDA] and anaemia of chronic inflammation [ACI]. Impaired intestinal iron absorption due to inflammatory cytokines is thought to play a role in ACI. We undertook for the first time a controlled prospective study investigating effects of differing underlying diseases, disease locations, and types of iron deficiency or anaemia on oral iron absorption in adult IBD patients with and without inflammation.

METHODS

This study was a comparative, single-centred open clinical trial in adults with IBD [n = 73] and healthy controls [n = 22]. Baseline parameters included blood count, iron status [ferritin, transferrin, transferrin saturation, soluble transferrin receptor, hepcidin, serum iron], high-sensitivity C-reactive protein [hsCRP] and interleukin-6. Iron absorption was tested using one oral, enteric-coated capsule containing 567.7 mg iron[II]-glycine-sulphate complex. Serum iron was determined 60/90/120/180/240 min after ingestion.

RESULTS

Iron absorption capacity was shown to be influenced by inflammation and anaemia or iron deficiency [ID] type but not by underlying disease type or localisation. The ACI group showed a significantly lower iron absorption capacity than all others. Whereas hsCRP levels [-0.387, p < 0.001], IL-6 [-0.331, p = 0.006], ferritin [-0.531, p < 0.001], and serum hepcidin [-0.353, p = 0.003] correlated negatively with serum iron change at 2 h, transferrin showed a positive correlation at the same time point [0.379, p < 0.001].

CONCLUSIONS

Underlying disease type and localisation appear to have little effect on iron absorption capacity, whereas lack of response to oral iron correlates well with serum markers of inflammation. Iron absorption capacity is thus significantly reduced in the presence of inflammation.

1036 Prognostic role of left ventricle longitudinal strain for the prediction of survival after surgical ventricular repair

Background

Surgical ventricular repair (SVR) in patients with ischemic cardiomyopathy is aimed to reshape left ventricle (LV) and reduce its volume in order to improve prognosis and quality of life. There are controversies regarding benefit of SVR, especially in patients with severely enlarged LV.

Purpose

Our purpose was to investigate prognostic value of LV longitudinal strain for survival and for the improvement of LV function after SVR in patients with anteroapical LV aneurysm.

Methods

218 pts (2005-2018, mean age 63.6 ± 11.2y, 73.9% males) with anteroapical LV aneurysm due to myocardial infarction underwent SVR combined with coronary bypass grafting (77.5%), mitral valve repair (18.3%) and LV thrombectomy (22.0%). Preoperative strain analysis was done retrospectively for 146 patients. Prognostic value of strain was tested in pts according to the LV end systolic volume index (LVESVI) with the cut-off value of 60ml/m². In 17 pts 1-year follow-up with strain quantification was done.

Results

During a median follow-up of 3.9 years (IQR: 1.0-6.8 years) there were 68 deaths and 1 patient was lost to follow-up. 30-days survival rate was 93.5% (95%CI: 90.3; 96.9%), 5 year survival – 72.5% (95%CI: 66.0-79.6%). Pts who died were significantly older, with higher proportion of diabetes (DM), peripheral artery disease, renal failure (RF) and atrial fibrillation (AF). Baseline ejection fraction (EF) and global longitudinal strain (GLS) did not differ significantly. Whereas basal longitudinal strain (BLS) was higher (more negative) in pts who survived (-11.4 ± 3% vs. -10.1 ± 4%, p = 0.027). Risk stratification by tertiles revealed that BLS was a significant predictor of survival. The risk of dying was 3 times higher for pts in the lowest tertile compared to those in the highest tertile (HR: 2.94, 95%CI:1.37-6.25, p = 0.013). When adjusted to age, AF, DM, RF, and previous heart surgery, BLS was an independent predictor of death (HR = 1.14, 95%CI:1.03;1.26, p = 0.032). At 1-year follow-up (12.7 ± 5.1 months) there was significant decrease of LV end-diastolic and end-systolic volume indices, from 102.8 ± 24.1 ml/m² to 77.9 ± 24 ml/m² (p &lt; 0.001) and from 67 ± 23.2 ml/m² to 44.3 ± 7.6 ml/m² (p &lt; 0.001), correspondingly, and increase of EF from 36.3 ± 9.4% to 44.4 ± 7.6% (p = 0.001). The mean systolic GLS improved from -6.6 ± 2.6% to -8.7 ± 3.2%, p = 0.008. Among 81 segments with baseline hypokinesia, 44 segments (54.3%) recovered their contractility, 36 segments (44.4%) remained hypokinetic and 1 segment deteriorated to akinesia. Mean systolic strain of segments which showed recovery was -6.6 ± 4.0% compared to -3.8 ± 4.5% with no improvement (p = 0.005). Cut-off value of systolic strain for prediction of recovery was -5.4 % (AUC = 0.69, p = 0.004; PPV = 0.73, NPV = 0.61).

Conclusion

Our study demonstrates that BLS is an independent predictor of survival after SVR in patients with LV anteroapical aneurysm. Furthermore, higher systolic strain predicts recovery of LV regional function at 1-year after SVR.

Projecting Changes in Expected Annual Damages From Riverine Flooding in the United States

Inland flood risk in the United States is most often conveyed through maps of 1% annual exceedance probability (AEP) or "100-year" floodplains. However, monetary damages from flooding arise from a full distribution of events, including floods both larger and smaller than the 1% AEP event. Furthermore, floodplains are not static, since both the frequency and magnitude of flooding are likely to change in a warming climate. We explored the implications of a changing frequency and magnitude of flooding across a wide spectrum of flood events, using a sample of 376 watersheds in the United States where floodplains from multiple recurrence intervals have been mapped. Using an inventory of assets within these mapped floodplains, we first calculated expected annual damages (EADs) from flooding in each watershed under baseline climate conditions. We find that the EAD is typically a factor of 5-7 higher than the expected damages from 100-year events alone and that much of these damages are attributable to floods smaller than the 1% AEP event. The EAD from flooding typically increases by 25-50% under a 1 °C warming scenario and in most regions more than double under a 3 °C warming scenario. Further increases in EAD are not as pronounced beyond 3 °C warming, suggesting that most of the projected increases in flood damages will have already occurred, for most regions of the country, by that time. Adaptations that protect against today's 100-year flood will have increasing benefits in a warmer climate by also protecting against more frequent, smaller events.