Outcome of traumatic thoracolumbar spine fractures in elderly: A systematic review

Introduction

Adequate guidelines for treatment of people over 65 years, suffering traumatic thoracolumbar spine fractures without neurologic deficit, are currently lacking.

Research question

The aim of this study was to systematically review the available literature regarding the outcome of conservative and surgical treatment of thoracolumbar spinal trauma in elderly patients.

Material and methods

A systematic review according the PRISMA guidelines was performed. Pubmed, Web of Science, EMBASE and the Cochrane Central register were searched until June 2021. Risk of bias of the included studies was evaluated. Clinical and radiological results, as well as complications of conservative or surgical treatment were reviewed.

Results

Six articles were included (one prospective randomized trial, two prospective and three retrospective cohort studies). In these studies conflicting results were observed with regard to pain, radiological results and complications following both conservative and surgical treatment strategies for thoracolumbar spine fractures in elderly.

Discussion and conclusion

Treatment of thoracolumbar fractures in elderly should focus on early mobilization to reduce complications and hospital stay. This may improve functional outcome and prevent worsening of frailty in this vulnerable group of patients. To elucidate the optimal treatment for elderly patient with thoracolumbar fractures, future research should focus on patient specific treatment rather than the mere difference between outcome of surgical and conservative treatment.

Sodium fluoride-induced autophagy of ameloblast-like cells via the p-ULk1/ATG13/LC3B pathway in vitro

OBJECTIVE

To investigate the effects of sodium fluoride on the ameloblast and reveal the mechanism of dental fluorosis.

MATERIALS AND METHODS

Mouse ameloblast-like cell line (ALC) cells were treated with various concentrations of NaF, and subjected to Incucyte, fluorescence immunoassay, transmission electron microscopy, reverse transcription quantitative polymerase chain reaction (RT-qPCR), western blot for autophagy examination, alkaline phosphatase and alizarin red staining for mineralization after osteogenic induction.

RESULTS

NaF exerts a dose-dependent inhibitory effect on ALC cell growth. TEM and fluorescence immunoassay showed that 1.5 mM or higher concentrations of NaF could induce a fusion of lysosome and mitochondria, finally increasing the number of autophagosome. RT-qPCR and western blot showed that the upregulation of autophagy related gene 13 (ATG13), downregulation of phosphorylated Unc-51-like kinase 1 (p-ULK1) were found in NaF-induced autophagy of ALC cells. The knockdown of ATG13 could rescue it as well as the expression of p-ULK1 and LC3B. Besides, alizarin red staining showed that fluoride under these concentrations could promote the mineralization of ALC.

CONCLUSIONS

The data show that fluoride in higher concentration can induce autophagy via the p-ULk1/ATG13/LC3B pathway of ALCs than lower ones promote mineralization in vitro, which provides insight into the function of NaF in the autophagy and mineralization of ameloblast.

[Pharmacogenetic testing improves treatment responses in patients with PLA2R-related membranous nephropathy]

OBJECTIVE

To evaluate the value of pharmacogenetic testing for improving the efficacy and safety of treatment with cyclosporine, tacrolimus, and cyclophosphamide (CTX) for PLA2R-related membranous nephropathy and for determing individualized and precise treatment plans for the patients.

METHODS

A total of 63 patients with PLA2R-related membranous nephropathy hospitalized in the Department of Nephrology at our hospital from January, 2019 to October, 2021 were enrolled in this study. Thirty-three of the patients underwent pharmacogenetic testing before taking the immunosuppressive drugs selected based on the results of genetic screening for sensitive targets, and the other 30 patients were empirically given immunosuppressive drugs according to the guidelines (control group). The clinical efficacy and adverse effects of the immunosuppressive drugs were analyzed for all the patients. The two groups of patients were compared for demographic and biochemical parameters including 24-h urine protein, serum albumin, renal function, and serum anti-phospholipase A2 receptor antibody both before and at 3 months after the beginning of the treatment.

RESULTS

Among the 33 patients undergoing pharmacogenetic testing, 51.5% showed a GG genotype for cyclosporine, and 61.6% had an AG genotype for tacrolimus; for CTX, 51.5% of the patients showed a homozygous deletion and 63.6% had an AA genotype. After treatment for 3 months, serum anti-phospholipase A2 receptor antibody, 24-h urine protein, and serum albumin levels were significantly improved in pharmacogenetic testing group as compared with the control group (P < 0.05).

CONCLUSION

Individualized and precise administration of immunosuppressive drugs based on pharmacogenetic testing better controls proteinuria and serum antiphospholipase A2 receptor antibodies and increases serum albumin level in patients with PLA2R-related membranous nephropathy.

[Effect analysis of myectomy guided by personalized three-dimensional reconstruction and printing in the treatment of obstructive hypertrophic cardiomyopathy]

Objective: To examine the clinical efficacy of myectomy guided by personalized three-dimensional reconstruction and printing for patients with obstructive hypertrophic cardiomyopathy. Methods: The clinical data of 28 patients with obstructive hypertrophic cardiomyopathy, who underwent septal myectomy guided by personalized three-dimensional reconstruction and printing in the Department of Cardiaovascular Surgery, Guangdong Provincial People's Hospital from May 2020 to December 2021, were retrospectively analyzed. There were 14 males and 14 females, aging (51.1±14.0) years (range: 18 to 72 years). Enhanced cardiac computed tomography images were imported into Mimics software for preoperative three-dimensional reconstruction. The direction of the short axial plane of each segment was marked perpendicularly to the interventricular septum on the long axial plane of the digital cardiac model, then the thickness was measured on each short axial plane. A figurative digital model was used to determine the extent of resection and to visualize mitral valve and papillary muscle abnormalities. Correlation between the length, width, thickness, and volume of the predicted resected myocardium and those of the surgically resected myocardium was assessed by Pearson correlation analysis or Spearman correlation analysis. The accuracy of detecting mitral valve and papillary muscle abnormalities of transthoracic echocardiography and three-dimensional reconstruction was also compared. Results: There was no death or serious complications like permanent pacemaker implantation, re-sternotomy for bleeding, low cardiac output syndrome, stroke, or multiple organ dysfunction syndromes in the whole group. Namely, the obstruction of the left ventricular outflow tract was effectively relieved. The systolic anterior motion of the anterior mitral valve leaflet was absent in all patients after myectomy. The length, width, and thickness of the predicted resected myocardium by three-dimensional reconstruction were significantly positively correlated with the length (R=0.65, 95%CI: 0.37 to 0.82, P<0.01), width (R=0.39, 95%CI: 0.02 to 0.67, P<0.01), and thickness (R=0.82, 95%CI: 0.65 to 0.92, P<0.01) of the surgically resected myocardium, while the relation of the volume of the predicted resected myocardium and the volume of the surgically resected myocardium was a strong positive correlation (R=0.88, 95%CI: 0.76 to 0.94, P<0.01). Importantly, the interventricular septal myocardial thickness measured by preoperative transthoracic echocardiography showed a moderate positive correlation with the volume of surgically resected myocardium (R=0.52, 95%CI: 0.19 to 0.75, P<0.01). During a follow-up of (14.4±6.8) months (range: 3 to 22 months), no death occurred, and 1 patient was readmitted for endocardial radiofrequency ablation due to atrial fibrillation. Conclusion: Personalized three-dimensional reconstruction and printing can not only visualize the intracardiac structure but also guide septal myectomy by predicting the thickness, volume, and extent of resected myocardium to achieve ideal resection.

O102 We know about left gastric artery embolisation and will embio provide the next solution to treat obesity?

Introduction

Left gastric artery embolisation (LGAE) is a minimally invasive procedure which has shown promising results for weight loss in recent studies and could play a key role as a treatment option in-between our current tier-3 and tier-4 services. Imperial College NHS Trust will sponsor the EMBIO trial, the first multi-centre double blinded randomised controlled trial comparing LGAE vs Placebo procedure to evaluate its efficacy on weight loss and obesity related comorbidities over a 12 month follow up period. Here, we perform a systematic review of the existing literature.

Methods

9 studies were reviewed. Studies which investigated weight loss as a % +- Ghrelin % change at 3,6 and 12 months were included as these pre-defined time points correlate with the EMBIO protocol. 6 studies met our inclusion criteria, 5 single arm studies and 1 single blinded RCT.

Results

N=62 patients were included in our analysis. Mean weight loss reported was 8.5%, 8.8% and 10% at 3, 6 and 12 months respectively post LGAE. Ghrelin levels reduced by 36%, 16.2% and 16.5% at 3, 6 and 12 months respectively post LGAE. To date, the only reported adverse events recorded include superficial gastric erosions healed on endoscopy by day 90 and one case of subclinical pancreatitis.

Conclusion

LGAE potentially offers a day case procedure under local anaesthesia and sedation to treat obesity and its metabolic complications. The EMBIO trial will provide level 1 evidence to confirm if LGAE is a viable intervention for obesity and evaluate its safety profile.

Take-home message

Left gastric artery embolisation could be the perfect solution to treat obesity in between existing tier-3 and tier-4 treatments.

161 THE ROLE OF THE GERIATRIC DAY HOSPITAL DURING THE COVID 19 PANDEMIC

Background

Methods

Results

Conclusion

163 EVALUATING THE ROLE OF THE GERIATRIC DAY HOSPITAL IN MEDICATION OPTIMISATION

Background

The geriatric day hospital (GDH) provides outpatient geriatric medical, nursing and rehabilitation care to older adults. The aim of this study was to assess whether medication optimisation occurs in this setting. We believe the GDH would be an ideal location for mediation optimisation due to the stable community dwelling patients and close follow up by specialised physicians.

Methods

Electronic patient records of the new patients ≥65 years seen in the GDH over a 3-month period were reviewed. Potentially inappropriate prescriptions (PIPs) and potentially prescribing omissions (PPOs) were identified using the STOPP/START prescribing tool on admission to the GDH and again at discharge from the GDH.

Results

One-hundred and sixty-seven patient records were reviewed; mean age 80.8 (SD6.5) years, 62.9% female, median clinical frailty scale score 6 (IQR5–6), mean number of conditions 5.79 (SD3), mean number of medications 7.57 (SD3.7). Patients had a median of 4 (IQR2–7) consultations. The number of patients prescribed at least 1 STOPP-PIP reduced by 10% (42.4% vs 38%; p &lt; 0.001). Vasodilator drugs in patients with orthostatic hypotension were deprescribed most frequently (6.5% vs 3%; p &lt; 0.001). PPOs were reduced by 36% (47.5% vs 30.6%;p &lt; 0.001). The largest improvement was identified in the prescription of vitamin D in patients experiencing falls (17.4% vs 13.8%;p &lt; 0.001). Logistic regression was performed to ascertain the influence of age, gender, falls, dementia, co-morbidity number and medication number on the likelihood of a patient experiencing a PIP or PPO. For every medication prescribed, the odds of experiencing a PIP increased by 11.8% (OR1.187, 95%CI 1.052–1.339). Being female increased the odds of experiencing a PPO by 21.7% (OR2.17, 95%CI 10.53–4.468).

Conclusion

Medication optimisation is key in avoiding side effects from potentially inappropriate medications. The frequency of patient attendances coupled with geriatricians’ expertise makes the GDH an ideal setting for medication optimisation in multi-morbid frail community-dwelling older adults.

Patterns of left ventricular recovery in patients with heart failure with mid-range ejection fraction

Background

Heart failure with mid-range ejection fraction (HFmEF) represents a new classification of heart failure with intermediate clinical characteristics to those with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). A proportion of HFmEF is attributed to atrio-ventricular dyssynchrony from atrial fibrillation (AF) as opposed to a primary cardiomyopathy with intrinsic cardiac myocyte dysfunction.

Purpose

We aim to compare the rate of left ventricular ejection fraction (LVEF) recovery in those with AF-mediated cardiomyopathy compared to those with primary myocyte dysfunction.

Methods

Consecutive patients with stable non-ischaemic cardiomyopathy with LVEF 40–49% on transthoracic echocardiography (TTE) were recruited from our institution's heart failure clinic and followed for 18 months. Patients with ischaemic, valvular or congenital heart disease, incomplete follow-up or poor quality TTE images were excluded. Eligible patients were separated into two groups: AF-mediated (n=44); and primary myocyte dysfunction (n=116).

Results

A total of 160 patients (62.1±16.4 years, 62% men) were included. There was no significant difference in age (p=0.06) and gender (p=0.59). Comorbid AF was higher in those with AF-mediated HFmEF (100 vs 28.4%; p&lt;0.01), otherwise no significant differences in clinical history was found between groups. AF-mediated HFmEF had lower rates of cardiac-specific beta-blocker use (15.9 vs 47.4%; p&lt;0.01). Baseline TTE showed similar LVEF and LV global longitudinal strain. On log-rank analysis there was no significant difference in all-cause death (p=0.75), or HF-related hospitalisation (p=0.14), however, higher rates of LVEF recovery were observed in the AF-mediated HFmEF group (p&lt;0.01). See figure 1.

Conclusion

There were higher rates of LVEF recovery in those with AF-mediated HFmEF compared to those with a primary myocardial disorder despite lower rates of cardiac-specific beta-blocker use. This did not translate to improvements in intermediate-term survival or HF related hospitalisation. These findings provide insight into the natural history of the disorder and its clinical phenotype.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Rate of LVEF Recovery

MiRNA-200a-3p suppresses the proliferation, migration and invasion of non-small cell lung cancer through targeting IRS2

OBJECTIVE

To uncover the biological role of microRNA-200a-3p (miRNA-200a-3p) in the progression of non-small cell lung cancer (NSCLC) and the underlying mechanism.

PATIENTS AND METHODS

The expression levels of miRNA-200a-3p and IRS2 in NSCLC tissues and cell lines were examined through quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The correlation between the miRNA-200a-3p level and pathological characteristics of NSCLC patients was analyzed. The prognostic value of miRNA-200a-3p in NSCLC was assessed through the Kaplan-Meier method. The potential interaction between miRNA-200a-3p and IRS2 was explored through Dual-Luciferase Reporter Gene Assay and Spearman correlation test. The regulatory effects of miRNA-200a-3p/IRS2 on the proliferative, migratory, and invasive abilities of NSCLC were evaluated by Cell Counting Kit-8 (CCK-8) and the transwell assay. The protein levels of the epithelial-mesenchymal transition (EMT)-related genes in NSCLC cells influenced by miRNA-200a-3p were detected by Western blot.

RESULTS

MiRNA-200a-3p was downregulated in NSCLC tissues and cell lines. The expression level of miRNA-200a-3p was related to tumor size, TNM staging, and lymphatic metastasis of NSCLC. The low level of miRNA-200a-3p predicted worse prognosis in NSCLC patients. The overexpression of miRNA-200a-3p inhibited A549 cells from proliferating, migrating, and invading. The protein levels of E-cadherin were upregulated, while N-cadherin and Vimentin were downregulated in A549 cells overexpressing miRNA-200a-3p. The Dual-Luciferase Reporter Gene Assay verified the binding between miRNA-200a-3p and IRS2. The level of IRS2 was negatively regulated by miRNA-200a-3p. Moreover, the overexpression of IRS2 could reverse the regulatory role of miRNA-200a-3p in the cellular behaviors of A549 cells.

CONCLUSIONS

MiRNA-200a-3p suppresses the proliferative, migratory, and invasive abilities of NSCLC by targeting IRS2, thus alleviating the progression of NSCLC.

Key changes in indices of myocardial work in cardiometabolic disease states

Background

Hypertension (HTN) and diabetes mellitus (DM) are prevalent cardiovascular disease states which have been shown to be associated with adverse cardiac remodelling and subclinical myocardial dysfunction. Myocardial work (MW) indices are novel non-invasive measures of left ventricular (LV) function. We aimed to characterise key differences in MW indices in patients with these conditions.

Methods

Outpatients with HTN and DM undergoing transthoracic echocardiography (TTE; 2016–2019) at our institution were assessed and compared to healthy controls. Only patients without cardiac disease with normal diastolic parameters on TTE were recruited. Patients with impaired LV function, cardiac ischaemia or arrhythmia, structural and valvular heart disease or poor-quality images were excluded. Recruited patients were stratified into 3 groups (Group1: Healthy Controls; Group 2: HTN; Group 3: HTN-DM). MW assessment was performed using GE E-95 EchoPac v2.2 system.

Results

Three hundred patients (57.3±17.4y, 51% female) were recruited. HTN and HTN-DM patients were associated with higher resting systolic blood pressure (SBP), indexed LV mass (LVMI), e' and E/e' compared to controls but no differences were noted in these parameters between HTN and HTN-DM. Global myocardial work index (GWI) was higher in HTN patients compared to Controls but not different compared to HTN-DM. Of interest, HTN-DM patients had higher global myocardial wasted work (GWW) and lower global myocardial work efficiency (GWE) compared to HTN patients and Controls.

Conclusions

MW indices may be a sensitive tool for the detection of subclinical changes in cardiac function in cardiometabolic disease states.

Funding Acknowledgement

Type of funding source: None

Effect of prevalent atrial fibrillation on cardiovascular outcomes in patients with chronic kidney disease

Background

The global increase in incidence and prevalence of chronic kidney disease (CKD) is associated with a parallel rise in co-morbid atrial fibrillation (AF). Concurrent presence of both conditions increases clinical complexity and may portend poor outcomes in this population.

Purpose

The aim of our study was to assess the impact of prevalent AF on mortality and cardiovascular outcomes in patients with CKD.

Methods

Consecutive patients with CKD (Stages 2 to 5) attending the Nephrology outpatient clinics in our health district between Jan 2007-Dec 2017 were retrospectively evaluated. Detailed appraisal of patient demographics, anthropometrics, clinical co-morbidities (including aetiology, stage and management of CKD) and pharmacotherapeutics was undertaken. These patients were followed for up to ten years for the composite outcomes of all-cause death and major adverse cardiovascular events (MACE). We excluded patients with incomplete clinical data and patients with concomitant medical co-morbidity limiting lifespan to &lt;6 months.

Results

2008 patients (63.61±17.17 yrs; 55.7% men) were assessed. The mean eGFR was 37.53±21.88 mL/min/m2. Patients with prevalent AF (n=440, 22%) were older (p&lt;0.01), with lower eGFR (p&lt;0.01) and higher rates of renal replacement therapy (p&lt;0.01). They also had a greater burden of coronary disease (p&lt;0.01), heart failure (p&lt;0.01), stroke (p&lt;0.01), obstructive sleep apnoea (p&lt;0.01), chronic obstructive pulmonary disease (p&lt;0.01), anaemia (p&lt;0.01) and obesity (p&lt;0.01). Over the mean follow-up period of 44.04±34.96 months, 832 patients met the composite outcome (410 all-cause death, 422 MACE). On log rank tests, prevalent AF was a predictor of the composite outcome (Figure 1; p&lt;0.01) and remained an independent predictor of all-cause death and MACE on multivariate analysis (HR 1.65; 95% CI 1.24–2.21, p&lt;0.01).

Conclusions

Prevalent AF is an independent predictor of all-cause death and MACE in patients with CKD.

Figure 1. Kaplan Meier Curve

Funding Acknowledgement

Type of funding source: None

Static accuracy of resistive bend sensors

Sensing of finger joint rotation can be difficult due to the hand's many degrees-of-freedom within a small space. Resistive bend sensors offer a potentially attractive option for making these measurements due to their low profile, small mass, and low cost. Further characterization of these bend sensors is needed, however, to ensure that readings are accurate. Specifically the static accuracy when bending and straightening the sensor has not been investigated. In this study, two-inch resistive sensors were bent from 0° to 90° and back to 0° while measuring the voltage output. Five calibration models were fitted to the measured data and used to determine the sensor's accuracy. When used with coated sensors, both the cubic and pchip models demonstrated non-monotonic behavior at low bend angles. Using uncoated sensors, the pchip calibration function and raw data resulted in a median error of 1.7° (SD 1.7°, range 12.1°).

A Study of the Safety and Functionality of Gamified Electromyographic Biofeedback for Children with Cerebral Palsy

Cerebral palsy is a neurodevelopmental condition that affects 17 million individuals worldwide. Traditionally, methods of therapy are repetitive and monotonous, generating immense difficulty in maintaining patient motivation and engagement. This project's objective was to provide a novel method of therapeutic intervention that was co-designed by therapists and had the capacity to increase patient motivation and enjoyment. The system developed incorporated the use of muscle activations retrieved from a bespoke surface electromyography subsystem, to control custom computer games to increase therapy uptake. The safety and functionality of this device was verified through a series of trials performed on adults without any muscular impairments. Furthermore, a feasibility evaluation was conducted whereby the system was demonstrated to a group of healthcare professionals to gain their feedback. The trial results confirmed the safety and functionality of the system, with professional therapists confirming its clinical potential and its perceived benefits.