6-month Period Research Articles

Widely Integrated Services in Home (WISH) for homebound older adults: a study protocol for a randomized encouragement trial.

Home-based primary care (HBPC) is an emerging patient-centered, interprofessional healthcare service model that can address unmet medical needs and care burdens for homebound older adults. In December 2022, the Ministry of Health and Welfare in South Korea launched the Home-Based Medical Center Demonstration project to provide a new bundle payment for physician home visits. In this study, we seek to determine whether the recently introduced HBPC services in South Korea have been associated with a reduction in long-term care (LTC) facility admissions and acute hospitalizations among homebound older adults. The study is a community-based, multicenter, two-arm, randomized encouragement design trial with a 12-month follow-up period (n = 600). Eligible study participants are community-dwelling LTC recipients with multimorbidity and functional deterioration. Study participants are recruited from five HBPC centers located in urban areas (Northeast Seoul, West Seoul, Daejeon, Wonju, and Paju). The study participants are randomly assigned to either the HBPC group or the usual care group with a 1:1 allocation ratio. Those assigned to the HBPC group receive longitudinal home visits at least once a month by an interprofessional HBPC team according to the Widely Integrated Services in Home (WISH) intervention protocol. This protocol adheres to the Integrated Care for Older People principles, which call for a person-centered assessment and broader integration of health and LTC services at the micro-, meso- and macro-levels. Primary outcomes of the trial are 1) between-group community survival days and 2) between-group potentially avoidable hospitalizations. Results of the treatment are estimated by both modified intention-to-treat and complier average causal effect analytic methods. This study aims to investigate the real-world effectiveness of HBPC on the reduction of LTC facility admissions and acute care hospitalizations in the community setting. The findings may inform healthcare policy decisions to expand HBPC services in South Korea and other countries. CRIS KCT0007921.

Enhancing patient activation: a controlled implementation study of an interprofessional evidence-based counseling program for complementary and integrative healthcare in cancer patients ('CCC-Integrativ').

Complementary and integrative healthcare (CIH) is increasingly recognized as a valuable approach to empowering and activating cancer patients. Studies have shown that higher patient activation is positively associated with improved health outcomes and reduced healthcare costs. The CCC-Integrativ study aimed to assess the implementation of an evidence-based counseling service on CIH at four Comprehensive Cancer Centers (CCC) in Germany. In this controlled implementation study, the patient-level intervention included three CIH consultations within a 3-month period delivered by interprofessional teams of physicians and nurses. The primary endpoint was patient activation using the PAM-13 at baseline (T1) and post-intervention (T2), and compared between control (CO, receiving routine care) and the intervention group (IG) using an analysis of covariance. Missing data were handled with multiple imputations. Maintenance effects at 6-month follow-up (T3) were investigated using a linear mixed model. A total of n = 1128 oncology patients (CO = 443, IG = 685) with diverse tumor entities and cancer stages were included in the study. The overall mean baseline PAM-13 score was 69.74 (SD = 14.24) (n = 959 (85.0%)). A statistically significant between-group difference in post-intervention PAM-13 scores was observed (Fgroup(1, 1866.82) = 8.634, P = 0.003), with an adjusted mean difference of 2.22 PAM-points. Age, gender, tumor entity, disease stage, or CCC study site did not significantly predict post-treatment PAM-13 scores. The maintenance effect of the intervention was not statistically significant (FtimeXgroup(1, 3316.04) = 2.337, P = 0.096). Individually tailored counseling on CIH, offered by specifically trained, interprofessional teams, significantly improved patient activation. Given the established positive effects of higher patient activation, the implementation of such a program at cancer centers may yield beneficial outcomes for both patients and the healthcare system.

Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial

ObjectiveThe study’s primary objective was to compare the effectiveness of intra-articular platelet-rich plasma injections versus corticosteroid injections for the treatment of cervical facetogenic pain. Secondary aims were to compare self-rated...

Campylobacter sputorum subsp. bovis subsp. nov., isolated from cattle, and an emended description of Campylobacter sputorum.

Six urease-negative Campylobacter strains were isolated from cattle faeces over a 19-month period from 2009 to 2010. These strains were initially identified as Campylobacter sputorum by 16S rRNA gene and atpA typing. Initial studies characterizing these strains by multilocus sequence typing and genome sequencing further supported their classification as C. sputorum but indicated that these strains form a divergent clade within the species. A polyphasic study was undertaken here to clarify their taxonomic position. Phylogenetic analyses were performed based on 16S rRNA gene sequences and the concatenated sequences of 330 core genes, with the latter analysis also placing the six strains into a clade distinct from the three C. sputorum biovars. Pairwise digital DNA-DNA hybridization values identified these strains as C. sputorum, and the pairwise average nucleotide identity values were consistent with those observed between current Campylobacter subspecies pairs. Standard phenotypic testing was also performed. All strains are microaerobic, anaerobic, motile, Gram-negative and oxidase- and catalase-positive; cells are curved rods or spirals. Strains can be distinguished from the C. sputorum biovars by the presence of alkaline phosphatase activity and triphenyltetrazolium chloride reduction and absence of nitrate reduction. The data presented here show that these strains represent a novel subspecies within C. sputorum, for which the name C. sputorum subsp. bovis subsp. nov. (type strain RM8705T=LMG 32300T=CCUG 75470T) is proposed.

Urinary Retention After GreenLight Laser Photoselective Vaporization of the Prostate (GLL.PVP) Surgery for Benign Prostatic Hyperplasia (BPH): A 3-6 Month Retrospective Follow-Up Study.

Objective Our study was designed to evaluate the postoperative urinary retention (UR) and success rate of the GreenLight Laser (Boston Scientific, Marlborough, MA, USA) photoselective vaporization of the prostate (GLL.PVP) procedure for Benign Prostatic Hyperplasia (BPH) patients, both with and without high-risk factors. Methodology We conducted a retrospective follow-up study of postoperative patients who underwent GLL.PVP for BPH. We collected data from clinical health records, including notes from the lower urinary tract symptoms (LUTS) clinic, trial without catheter (TWOC) clinic, and emergency department presentations with UR. The analysis examined several parameters, including the patient's age, high-risk factors, prostate volume, and both preoperative and postoperative objective voiding parameters. These voiding parameters included post-void residual (PVR) and maximum flow rate (Qmax). Additionally, the analysis looked into whether the patient had a catheter or experienced urinary retention prior to the surgery. Results A total of 50 GreenLight Laser PVP surgeries were performed over a 14-month period from May 2023 to July 2024 at West Middlesex University Hospital in London. Most of the patients were between the ages of 60 and 80. Prior to the surgery, data indicated that 17 patients (34%) were using long-term catheters, whereas 33 patients (66%) were not. Additionally, 25 patients (50%) were identified as having high-risk factors, which included being on anticoagulation therapy, a history of urinary retention, and a prostate volume exceeding 100 cc.Notably, the patient without h/o urinary retention had an average preoperative PVR of 150 mL and an averageQmaxof 7 mL/second In our 3-6 month retrospective postoperative follow-up study, we found that eight cases (16%) developed urinary retention, while 42 cases (84%) did not, with an average PVR volume of 105 mL and an average Qmax of 13.5 mL/second. In patients with preoperative urinary retention, 13 cases (76%) did not develop UR postoperatively whereas four cases (24%) developed. Conclusion Our study conclusively found that 42 cases (84%) of patients did not experience urinary retention (UR) in the follow-up after undergoing the GLL PVP operation, irrespective of any history of urinary retention or other high-risk factors. This unequivocally demonstrates the operation's efficacy. Furthermore, our findings revealed that three-quarters of patients with a preoperative history of urinary retention also did not develop UR post-surgery. The GLL.PVP procedure is safe and effective, leading to rapid improvements in voiding parameters.

Precarious and vulnerable work: The experiences of applied sport psychologists

This article analyzes the vulnerable and precarious nature of applied sport psychology practice. Adopting a longitudinal approach over an 18-month period, data were collected through 41 semi-structured interviews with six applied sport psychologists working across soccer, swimming, and athletics. Interviews took place at 6–8 week intervals, and transcripts were iteratively analyzed with Kalleberg’s theorization of precarity and Kelchtermans’ writings around vulnerability adopted as the primary heuristic devices. Four themes were identified, highlighting how: (a) “precarious employment conditions”; (b) “constrained decision making”; (c) “challenges to demonstrating impact”; and (d) “contrasting beliefs of appropriate practice” typified practitioners’ applied experiences. Our findings and analysis advance discussions about the precarious nature of applied sport psychology work by recognizing some of the inherent structural vulnerabilities that characterize the role. Insights developed from this research have important implications for the profession, including the preparation, development, employment and ongoing support of its workforce.

HPB SO09 - Review of the management and the outcome of acute pancreatitis in a tertiary centre in the United Kingdom

Abstract Background Acute idiopathic pancreatitis (IP) is a challenging condition in surgical practice. We undertook a prospective review of all patients presenting with idiopathic pancreatitis to identify the natural course of the disease. Method Fifty-nine patients were identified within a 12-month period from a prospectively maintained database. Patients were diagnosed with idiopathic pancreatitis (IP) following a standardised protocol excluding other causes of pancreatitis. Results Over one year, a total of 373 new patients with acute pancreatitis were admitted. IP constituted 15.8% of admissions; 15.2 % of which presented with severe pancreatitis. Average LOS for the index IP admission was 7.05 days, compared with 6.4 days for the rest of cohort. 8.47% with IP were re-admitted within 3 months of index admission, increasing to 13.6% over 12 months. Overall, 16.9% developed long term complications including pancreatic insufficiency or chronic pancreatitis over 12 months compared to 15.3% in the rest of AP cohort. The mortality rate was 3.4% and 12.1% in the IP and AP cohort respectively. Conclusion Idiopathic pancreatitis constitutes a larger burden than expected in a large prospective cohort of patients with AP. Patients with IP have a longer LOS and a high risk of long-term sequelae.

HPB SO46 - Risk Stratification for Acute Pancreatitis: A Retrospective Comparative Analysis between Glasgow-Imrie and BISAP Scoring Systems within a District General Hospital

Abstract Background Risk stratification for acute pancreatitis (AP) is an important tool in clinical decision making. The BISAP score has been validated to be a comparable risk prognostication tool to current models[1, 2]. Current trust practice is the Glasgow-Imrie score, which involves more invasive and non-routine investigations, resulting in an increased cost and labour burden. Additionally, a previous local audit demonstrated poor compliance with only 55% of admissions having a documented score, limiting utility and prognostication. By demonstrating non-inferiority, we aim to implement BISAP as the standard of practice with earlier severity assessment, improved patient experience and minimising unnecessary investigations. Method A retrospective analysis of 153 admissions with acute pancreatitis admitted to a single-site district general hospital over a 12-month period was performed, reviewing electronic patient records for documentation, observations and investigations. Both Glasgow-Imrie and BISAP scores were calculated within 48 and 24 hours of admission retrospectively and respectively. Descriptive statistics was used to summarise data and compare trends between both scores and the severity of acute pancreatitis, ICU admissions and mortality. Logistic regression was utilised to model the relationship between both systems and binary outcomes with area under the curve (AUC) and non-inferiority tests derived to determine efficacy. Results The cohort had a mean age of 57 ± 18.53 (52:48 male:female) with an average LOS of 7.25 ± 10.12 days. 6.54% had severe AP, 3.92% required ICU admisison and 3.26% mortality rate. The AUC value for both models was 0.868 in predicting severity (p<0.001) with Glasgow-Imrie performing better in predicting ICU admission (AUC 0.954 > 0.855, p<0.01) and BISAP outperforming Glasgow-Imrie in predicting mortality (AUC 0.903 > 0.867, p<0.01). Bootstrapping resampling demonstrated no significant difference between models in predicting severity (δAUC 0.0007, 95%CI -0.01181, 0.1167), ICU admission (δAUC 0.1010, 95%CI -0.0113, 0.2140) and mortality (δAUC -0.0366, 95%CI -0.0788, 0.0045). Conclusion Both the Glasgow-Imrie and BISAP scoring systems are accurate in predicting the severity of pancreatitis, ICU admission and mortality. The BISAP score is similar in prognostic accuracy to the Glasgow-Imrie score and is advantageous in being simpler to obtain in clinical practice with a higher rate of completeness. We recommend the BISAP score as a non-inferior, pragmatic risk stratification tool in acute pancreatitis.

BPE on contrast-enhanced mammography: relationship with breast density, age and menopausal status.

This retrospective study aimed to evaluate the relationship between BPE on CEM and breast density, age and menopausal status. Our analysis included all women eligible for CEM as a second-level examination in the diagnostic phase in a 12-month period. CEM were performed on a dedicated low-dose digital mammography unit after the injection of 1.5ml/kg body weight Iohexol 350 mgI/ml. Both breast composition and BPE were assessed independently by two breast radiologists according to the CEM supplement to the 2013 ACR BI-RADS Mammography. A two-stage ordered probit regression model was fitted to evaluate the relationship between BPE and the other factors considered. 49 patients were included (median age = 55years, 28.6% premenopausal and 71.4% postmenopausal). Breast composition was classified as ACR BI-RADS a in 4.1%, ACR BI-RADS b in 36.7%, ACR BI-RADS c in 46.9%, and ACR BI-RADS d in 12.2% of cases, by both Readers. A BPE 1 category was assigned in 53.1-55.1% of patients (by Reader 1 and 2, respectively), BPE 2 in 22.4%, BPE 3 in 18.4-12.2%, and BPE 4 in 6.1-10.2%. Higher breast density was strongly associated with higher levels of BPE, while BPE was not directly associated with age, both in fertile and postmenopausal patients. No significant differences were observed between the two Readers. Increased BPE is associated with a well-established breast cancer risk factor as high breast density, while it was not directly dependent on the other non-modifiable factors considered.

HPB SO26 - Evaluation of Theatre Database Accuracy in a Tertiary HPB Center According to NCIP Standards in the UK

Abstract Background The goal of creating the NCIP (National Clinical Improvement Programme) theatre data set discovery information system is to allow NHS Improvement to evaluate how theatre data can improve the attribution of surgical activities, as documented in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, to individual consultants. The success of NCIP is at risk due to the inaccurate attribution of existing activity data to consultants. Method The NCIP theatre database for the Hepato-Pancreato-Biliary (HPB) surgery department was compiled over a 12-month period (from April 2022 to April 2023) and analyzed based on the operating consultant recorded in the operative notes, clinical letters, and the Carfelow system (admitting office records). Results In Nottingham University Hospitals (NUH), 143 major liver and pancreatic resections were performed, including 38 Whipple’s procedures (both classic and Pylorus-preserving Pancreatico-Duodenectomy), 19 Distal Pancreatectomies, and 86 Liver resections. Of these, only 58 patients (40.6%) had correct entries in the NCIP database regarding the operating surgeon. The NCIP data inaccuracies for the operating consultant were 65.8% (25/38) for Whipple’s procedures, 57.9% (11/19) for Distal Pancreatectomies, and 56.97% (49/86) for Liver resections. Conversely, the NCIP data was 100% accurate concerning the assigned consultant on Careflow, which matches the clinical letters from the outpatient clinic. Conclusion The gap between the NCIP database and the admitting office database leads to inaccurate attributions of surgical activity. This hinders learning and improvement efforts essential for achieving program benefits and prevents providers from complying with license conditions and delivering efficient healthcare services. To ensure accurate HES data, admitting officers should request proper communication and accurate consultant codes from consultant secretaries to ensure accurate data across the different hospital systems

OGC SO32 - Propensity score analysis of the impact of deprivation and the COVID-19 pandemic on Upper Gastro Intestinal (UGI) cancer surgery outcomes

Abstract Background Deprivation is a complex, multifaceted concept, not synonymous with poverty, but with the potential to widen health inequalities. This study aimed to explore demographic disparities in patients undergoing UGI cancer surgery in a UK regional cancer network during the COVID-19 pandemic. Method Consecutive 881 patients were studied prospectively (median age 67 (24 - 89) yr., 703 m, 178 f; 518 oesophageal, 363 gastric; 837 Adeno-, 44 SCC) over 13 years. The COVID-19 pandemic was defined as the 24-month period from February 1, 2020 to January 31, 2022, during which 118 patients were treated. The demographic profile of the pandemic cohort was compared with that of the 763 patients treated outside this period incorporating a propensity score analysis. Primary outcomes were operative morbidity, mortality, and one-year survival. Wales’ Index of Multiple Deprivation was used to assess deprivation disparity. Results A 24% reduction in the number of cancer operations was observed during the first pandemic year. No difference was observed in age, gender, histology, tumour site, ASA grade, or oncological treatment. During COVID-19 the proportion of patients from the two most deprived quartiles receiving potentially curative surgery fell from 53.2% to 40.7% (p=0.012). No difference was observed in severe morbidity (Clavien-Dindo >3, 22.2% vs. 19.8%, p=0.897), 30-day mortality (2.5% vs. 2.4%, p=0.886), or one-year survival (82.4% vs. 78.8%, p=0.374). Conclusion UGI cancer surgery safely continued during COVID-19, but patients from areas of high deprivation were over 20% less likely to access curative surgical treatment compared with before and after COVID-19. This emphasises the need for bespoke strategies to mitigate the disproportionate impact of any future pandemic on patients living in deprived geographical areas.

Variation in adherence measures as a function of calculation methods

AimWe aim to compare different operational definitions of medication adherence as well as examine the within-patient variability among these measures among patients treated for multiple comorbid conditions.MethodsElectronically monitored adherence data from a study on comorbid conditions were examined using three different calculation methods. DAILY adherence calculated the number of administrations divided by the number prescribed, without considering inter-dose interval. TIMING used predefined inter-dose intervals. Measures were aggregated to six 30-day periods. A PILLCOUNT approach counted the total administrations divided by the expected number in each 30-day period. Within-patient variability was computed based on DAILY and TIMING results for each 30-day period.ResultsResults varied by adherence calculation method. PILLCOUNT demonstrated the largest adherence rates (89%–92%); DAILY rates were lower (79%–85%); and TIMING was the lowest (62%–68%) over the 6-month period. TIMING within-patient variability (29%–35%) was larger than DAILY (20%–25%).DiscussionDifferences among the three methods confirm the importance of the adherence definition. TIMING may underestimate medicinal effects because patients may take medication as instructed (e.g., with meals) rather than at fixed intervals. PILLCOUNT may overestimate adherence by not accounting for inconsistent use. DAILY may best provide daily estimates of correct administration. Higher variability for TIMING may indicate patients are more likely to vary time between doses. Adherence calculation methods are important in interpreting results. Variability measures provide a more complete picture of adherence and may raise the likelihood of effects on biological outcomes. We propose studies of adherence include calculation method in the definition of adherence.

OGC SO16 - International upper GI robotic fellowship on the CMR Versius platform

Abstract Background The impetus for UGI surgery trainees to attain skills in robotic surgery is likely to increase following the global acceptance and utilisation of robotic platforms. UGI robotic fellowship programs are few in number and highly desirable providing trainees with a unique selling point when embarking on independent consultant practice. We describe the first UGI robotic surgery fellowship on the CMR Versius platform at the Gloucestershire Royal Hospital which has the largest experience of UGI robotic surgery on the CMR Versius platform in the UK, having performed over 200 cases including the first robot assisted minimally invasive oesophagectomy. Method A structured robotic training curriculum was created in collaboration with CMR Versius. It consists of a pre-clinical phase of E-learning (10 modules), simulator training (16 assessed tasks) and dry-laboratory training (a two-day course encompassing robotic system set-up, bed-side assist and assessed dry lab practical tasks). The clinical phase begins with bed-side assisting of robotic cases followed by supervised operating on the console. Operations performed on the console are recorded for review and evaluation. The videos will be scored by two independent surgeons using the modified Global Evaluation Assessment of Robotic Skills (mGEARS) score to track growth and progress. Results The E-learning modules and assessments were completed prior to commencement of the fellowship. The remainder of the pre-clinical phase of the curriculum were completed within 4 weeks of commencement followed by bed-side assisting. Once competent at bed-side assisting and able to demonstrate proficiency in set-up (selecting port site placement, docking, arm spacing and configuration), supervised console training was commenced 6 weeks into the fellowship. Console training began with robotic assisted laparoscopic assisted cholecystectomy to gain familiarity, confidence, and efficiency. After 6 cases as the only console surgeon, the surgical complexity of cases was progressed to hiatal surgery and Heller’s cardiomyotomy Conclusion A structured training curriculum with defined phases provides a feasible and effective framework for robotic fellowship training. Adherence to the pre-clinical phase of training allows safe and efficient progression to hands-on console experience. This is achievable within relatively short timeframe to allow for ample independent console surgeon experience and the development of proficiency within a 12-month fellowship period.

Long-Term Changes in Tibial Plateau Angle (TPA) Following Tibial Plateau Leveling Osteotomy (TPLO) in Dogs—A Retrospective Study

Background: Cranial cruciate ligament rupture is a common orthopedic condition in dogs. Tibial plateau leveling osteotomy (TPLO) is a widely accepted method due to its success in stabilizing the stifle joint. This study aims to investigate the changes in the TPA over a 12-month follow-up period in dogs undergoing TPLO. Methods: An analysis of medical records from 60 dogs, aged 2 to 8 years and weighing between 7 and 59 kg, who underwent the TPLO procedure was conducted. TPA measurements were recorded before surgery, immediately after surgery, and during follow-up periods at 8 weeks, 6 months, and 12 months post-operation. Results: Results showed a consistent increase in TPA over time, with the mean TPA rising from 4.98 degrees immediately post-surgery to 9.02 degrees at the 12-month follow-up. No patients exhibited a decrease in TPA during the study period. The mean difference between the final and initial TPA was 4.045 degrees, with patients exhibiting smaller initial TPAs showing less variation over time; Conclusions: This is the first report on long-term TPA changes following TPLO, offering essential insights into tibial remodeling and the potential for optimizing surgical outcomes. Based on the results, achieving a lower initial TPA (1–2 degrees) may reduce postoperative TPA changes, supporting more stable stifle function.

Asymptomatic parasitic worm thelazia callipaeda infection found during phacoemulsification: A case report

Introduction:We report a case of asymptomatic thelazia callipaeda infection discovered incidentally during phacoemulsification cataract surgery in March 2024. Case presentation: A 77-year-old male patient presented with complaints of blurred vision. During a slit-lamp examination, trichiasis was observed, but the patient had no foreign body sensation or itching. He was diagnosed with cataract and underwent phacoemulsification cataract surgery. During the surgery, a white, wriggling worm was discovered in the conjunctival sac and removed. It was later identified as thelazia callipaeda. The surgical eye was thoroughly washed and received anti-inflammatory medication postoperatively. No recurrence or new symptoms were reported during the 3-month follow-up period. Conclusions: Thelazia callipaeda infection can be asymptomatic and incidentally discovered. A detailed preoperative examination, such as turning over the upper and lower eyelids to check the conjunctival sac, is necessary before the surgery. When a worm is discovered during surgery, it is crucial to remove it completely and thoroughly clean and disinfect the conjunctival sac.

Burden of post-acute COVID-19 sequelae in healthcare workers and its course over a 30-month period-results from a prospective multicentre cohort.

As healthcare workers (HCW) have been disproportionally affected by COVID-19, its post-acute sequelae (PASC) in HCW can impact healthcare systems. We assessed the burden and course of PASC in HCW over a 30-month period. In a prospective multicentre HCW cohort in Switzerland, PASC surveys were conducted in 03/2021, 09/2021, 06/2022, 04/2023, and 10/2023. Stratified by viral variant at first infection, the prevalence of PASC symptoms, self-experienced PASC and the Post-COVID Functional Status (PCFS) were analysed cross-sectionally in 10/2023, self-perceived success of therapeutic measures used was assessed. The evolution of PASC symptoms and PCFS in Wild-type and non-Wild-type infected HCW compared to uninfected controls was analysed longitudinally across all surveys. In cross-sectional analysis, 1704 HCW (median age 47years, 82.2% female) were included. Thereof, 30.7% reported ≥ 1 PASC symptom in 10/2023, with 115 (6.7%) stating to have or have had PASC. Both were most common after Wild-type infection compared to other variants. Overall, 17/115 (15%) indicated relevant/severe restrictions in their daily activities and of 85 (74%) that tried ≥ 1 measure against their symptoms, 69 (81%) reported having benefitted. Longitudinal analysis (n = 653) showed a significantly higher proportion of Wild-type infected HCW to report PASC symptoms compared to controls in 03/2021 (+ 21%, 95% CI 4-39), with decreasing trend (+ 7%, 95%CI -10-25 in 10/2023). This effect was not evident for non-Wild-type infected HCW. Over a 30month period, overall PASC burden in our HCW cohort decreased, although 1% still experience relevant restrictions in their daily life; Wild-type infected individuals show the highest disease burden.

Abstract 4141439: Catheter ablation and clinical outcomes among older Medicare beneficiaries with atrial fibrillation

Background: Catheter ablation (CA) is increasingly used for treatment of atrial fibrillation (AF). However, CA has not been widely adopted in the older population with AF. The aim of this study is to examine the risks of adverse outcomes following CA in older people with AF. Methods: Using 2014-2019 Medicare claims, we conducted a propensity score analysis of patients treated with CA within 6 months of new AF diagnosis to patients treated with only antiarrhythmic therapy in the 6-month period. The outcome follow-up began after the 6-month period. Cox proportional hazards models were used to estimate hazard ratios (HR) for the composite and individual endpoints from CABANA trial (death, stroke, major bleeding or cardiac arrest) and CASTLE-AF trial (death or heart failure). Subgroup analyses were performed by sex, race-ethnicity, social deprivation index, frailty and dementia. Results: The study population comprised of 14623 AF patients (mean age, 76.1±7.6 years; 55% female, 28% frailty, 13% dementia), including 8% receiving CA. The mean follow-up was 1.8 years. Compared to patients with only antiarrhythmic therapy, patients treated with CA had lower rates of CABANA endpoints (CA vs antiarrhythmic therapy: 5.6 vs 11.7 per 100 person-years; HR:0.72, 95%CI:0.66-0.77) and CASTLE-AF endpoints (6.5 vs 13.8 per 100 person-years; HR:0.72, 95%CI:0.67-0.78). The benefits of CA were consistent in both female and male for CABANA endpoints (female: HR:0.71, 95%CI:0.64-0.79 and male: HR:0.72, 95%CI:0.65-0.81) and CASTLE-AF endpoints (female: HR:0.65, 95%CI:0.59-0.73 and male: HR:0.78, 95%CI:0.71-0.87), and in both frail and non-frail patients for CABANA endpoints (frail: HR:0.72, 95%CI:0.66-0.80 and non-frail: HR:0.70, 95%CI:0.63-0.77) and CASTLE-AF endpoints (frail: HR:0.89, 95%CI:0.81-0.97 and non-frail: HR:0.69, 95%CI:0.63-0.75). Similar trends were observed for subgroups defined by race-ethnicity, social deprivation index, and dementia. Conclusions: These findings suggest that CA may be beneficial for older AF patients. Nonetheless, further investigation of the safety and efficacy of CA given to older patients in well-designed interventional trials are warranted.

Volumetric changes of porcine collagen matrix and free gingival grafts for soft-tissue grafting to increase the width of keratinized tissue around dental implants: a retrospective clinical study.

To compare three-dimensional changes of aporcine derived collagen matrix (CM) and free gingival grafts (FGG) for increasing keratinized tissue (KT) at dental implants over a 24-month follow-up period. This retrospective study enrolled 25 patients exhibiting 41 implants with deficient KT width (i.e., < 2mm) who underwent soft tissue augmentation using either CM (11 patients/15 implants) or FGG (14 patients/26 implants). The primary outcome was tissue thickness change (mm) at treated implant sites between 1- (S0), 12- (S1), and 24-months (S2). Secondary outcome was the changes of KT width over a 24-month follow-up period. Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of -0.05 ± 0.35mm and - 0.31 ± 0.41mm in the CM group, and - 0.23 ± 0.38mm and - 0.22 ± 0.81mm in the FGG group, with no significant differences found between the groups (S0-S1: p = 0.14, S0-S2: p = 0.58). Within S1 and S2, the CM and FGG groups displayed comparable tissue thickness reduction (CM: -0.32 ± 0.53mm, FGG: -0.02 ± 0.21mm; p = 0.07). The FGG group exhibited a significantly greater KT gain 24-months compared to the CM group (CM: 1.50 ± 1.14mm, FGG: 4.04 ± 1.65mm; p < 0.001). CM and FGG were associated with comparable three-dimensional thickness changes over a period of 24 months. A significantly wider KT band could be established in the FGG group.

Abstract 4137854: Effect of Sacubitril/valsartan on Left Ventricular Tissue Characterization in Heart Failure with Left Ventricular Ejection Fraction Below 50%

Background: The effects of sacubitril/valsartan (ARNI) on myocardial tissue characterization in heart failure (HF) with left ventricular ejection fraction (LVEF) &lt;50% are still unclear. Objective: The present study investigated the effects of 9 months of ARNI treatment on LV structure and myocardial tissue characteristics in HF with LVEF &lt;50% using cardiac magnetic resonance (CMR). Methods: This study was a prospective, 2-arm, randomized, open-label clinical trial (SAVE-HF). Sixty-four HF outpatients with LVEF&lt;50% were randomized 1:1 from ACE inhibitor/ARB to ARNI (ARNI group) or control group (continued ACE inhibitor/ARB). CMR was performed to evaluate LV structure and tissue characteristics, including changes in LV extracellular volume fraction (delta ECV) before and after the 9-month period. The primary endpoint was difference in ECV between the two groups. Secondary endpoints included changes in LV volumes and mass, LVEF, extracellular mass (ECM) calculated as LV mass times ECV/100, and intracellular mass (ICM) calculated as LV mass minus ECM. Results: A total of 59 of 64 stable patients (68±12 years; 52 men) completed the 9-month intervention followed by repeated CMR. ARNI decreased systolic BP levels from the first month by approximately 10 mmHg. ARNI group exhibited significant reductions in LV end-diastolic and end-systolic volumes and LV mass. While LVEF and ECV remained unchanged (31.6±5.0 vs. 31.9±5.0%, p=0.26), both ECM and ICM significantly decreased after ARNI. In the control group, systolic BP, LV volumes and LV mass, ECV, ECM and ICM were unchanged. Comparing the two groups, while delta ECV was not significantly different, delta ECM was greater in ARNI group than control group (-3.6±7.3 vs. 0.2±5.3 g, p=0.025), indicating improved LV tissue characteristics. Conclusions: ARNI reduced LV volume and LV mass, accompanied with reduction of both ECM and ICM, and consequently unchanged ECV. These findings may suggest that ARNI may improve LV tissue characteristics and protect from LV remodeling in HF patients with their LVEF&lt;50%.

Large, but short-term, increase in fecal indicator bacteria following extreme flooding from Hurricane Harvey in Houston, TX

Hurricane Harvey caused widespread flooding along the Texas Gulf Coast in August 2017; some areas of Houston received &amp;gt;150 cm of rainfall within a few days. Due to concerns over fecal contamination of floodwaters, surface water samples were collected at six locations in the southeastern Houston area immediately before and after the hurricane and then every 1 to 2 weeks thereafter over a 2-month period. Total E. coli was enumerated using the IDEXX Quanti-Tray/2000 system. DNA extracted from water samples was analyzed via quantitative real-time PCR (qPCR) for general and source-specific total Bacteroidales and human Bacteroidales markers, and digital PCR (dPCR) for antibiotic resistance genes (ARG) and a plasmid (pBI143) associated with human waste. SourceTracker2 was used to determine human source contributions based on metagenomic analysis of PCR-amplified 16S rRNA gene fragments. Samples collected immediately after the hurricane had elevated levels of E. coli, ranging from 488 to 1,733 CFU 100 ml−1. After 1 week, E. coli levels decreased to &amp;lt;100 MPN 100 ml−1. Total Bacteroidales numbers were elevated immediately following the hurricane and remained high for 12 days. Human-source contributions, as assessed by PCR methods and metagenomic analysis, peaked within 12 days after the hurricane consistently across all sampling sites. Multiple regression analysis of environmental parameters, copies of ARG and pBI143, and metagenomic data confirmed that human waste caused the dramatic, short-term, high levels of fecal contamination of floodwaters generated by Hurricane Harvey. Fecal indicators approached normal background levels approximately 3 weeks after the rainfall ended.