Comparison Of Outcomes Research Articles

Comparative outcome of different treatment options for acetabulum fractures in elderly individuals—a retrospective analysis of 207 patients

Purpose Acetabular fractures are challenging injuries in the heterogeneous population of elderly patients. In patients able to partially bear weight, open reduction and internal fixation (ORIF) is indicated. In frail patients, ORIF combined with primary total hip arthroplasty (THA) allows early weight-bearing to preserve independence. This article systematically analyses a treatment algorithm that separates fractures into stable fractures treated conservatively and fractures needing surgical stabilization with osteosynthesis or osteosynthesis plus arthroplasty, dependent on patient characteristics but less on the fracture classification or energetic impact of the trauma. Methods Data on patients ≥50 years of age treated for acetabular fractures (2009–2019) were retrospectively analyzed. The primary outcome was loss of independence. In-hospital complications, length of stay, re-operations, the need for walking aids, and pain were analyzed as secondary outcomes. Results Out of 207 patients, 135 were male, average age was 70 years. Eighty-five patients were treated conservatively, 89 ORIF, and 33 ORIF plus arthroplasty in one operation. The initial morbidity of patients treated with the combined operation was higher than osteosynthesis alone, but the long-term outcome was favorable with less pain and fewer secondary interventions. Age and female gender were associated with the decision to treat the fracture with the combination of osteosynthesis and arthroplasty. Conclusions The results suggest that aged and potentially frail patients with acetabular fracture have better long-term outcome after ORIF combined with arthroplasty at the price of an initially higher risk of adverse outcomes. Females were more frequently treated with the combined operation independent of other risk factors

Feasibility and outcomes of ultrasound-guided transcutaneous access to the axillary vein for implantation, revision, and upgrade of cardiac electronic devices

Abstract Background Implanting leads for cardiac implantable electronic devices (CIED) requires venous access. Venous access is commonly established through the cephalic and subclavian vein. For CIED upgrades or revisions, the preferred cephalic vein access is often not viable. Several reports suggest that fluoroscopy-guided axillary vein puncture may reduce thoracic complications. Purpose This study reports on procedural outcomes of ultrasound-guided axillary vein access for CIED implantation, revision, or upgrade in a large tertiary care centre. Outcomes were compared to the traditional subclavian vein approach. Methods This retrospective, single-center non-randomized study, conducted from January 2021 to August 2023, analyzed patients undergoing CIED implantation, revision, or upgrade. Axillary access, initially introduced by one operator, was increasingly adapted by additional operators. The axillary access was obtained by ultrasound-guided visualization of the axillary vein at the deltopectoral groove (Figure 1A and B). Subsequently, the wire(s) were transcutaneously inserted. An adjacent skin incision allowed for threading the wire(s) followed by standard lead implantation (Figure 1C). The study evaluated the acute success of each venous access method and the incidence of adverse events. Those were defined as pneumothorax, hemothorax, and pocket hematoma. An intention-to-treat analysis was performed. A p-value assessed the comparative outcomes between the axillary and subclavian access methods. Results In this study, 986 patients (mean age 74, IQR 64-82 years, 35% women) underwent CIED implantation, revision, or upgrade with 1636 lead implants. Axillary access was used in 578 patients with 532 (92%) successful implantations. Subclavian access yielded a higher success rate with 394/408 patients (97%) (p=0.003). For device upgrades or revisions specifically, axillary access was successful in 68/79 patients (86%), versus 44/47 patients (94%) with subclavian access (p=0.193). Acute complications were less frequent with axillary access (0.3%, 2/578 patients) and consisting of two cases of pneumothorax requiring intervention. In CIED implantations via subclavian access, complications occurred in 17/408 patients (4.2%) (p<0.001) including pneumothorax in 12 patients (2.9%, with 2% requiring intervention), hemothorax in three patients (0.7%), and pocket hematoma in two patients (0.5%). No additional complications were observed in the axillary group. Conclusion The implementation of transcutaneous, ultrasound-guided axillary access for CIED implantations, revisions and upgrades in a major CIED training centre is feasible. Complication rates were low compared to subclavian venous access.Figure 1

Evaluation of adipose-derived stem cells (ASCS) exosome implantation and platelet-rich fibrin (PRF) on critical long bone defects in Sprague-Dawley rats.

This study aimed to assess the efficacy of adipose-derived mesenchymal stem cell exosomes (ASCs exosome) and platelet-rich fibrin (PRF) in treating critical long bone defects in Sprague-Dawley rats. Critical long bone defects, defined as exceeding 2cm or 50% of the bone diameter, often pose a healing challenge. While autologous bone grafts have been considered, they have shown unreliable results and donor-site complications, necessitating alternative treatments. The research followed a quasi-experimental post-test only control group design involving 30 male Sprague-Dawley rats. The rats were divided into five groups and subjected to femur bone defect creation, internally fixed with a 1.4mmK-wire, and treated with various combinations of hydroxyapatite (HA), bone graft (BG), ASCs exosome, and PRF. Histomorphometry and BMP-2 gene expression analysis were performed to evaluate bone healing. The results indicated that the group treated with HA+BG+ASCs exosome (group IV) exhibited the highest BMP-2 gene expression, while group III (HA+BG+ASCs exosome+PRF) had the highest chordin level. Overall, groups receiving ASCs exosome or PRF intervention showed elevated BMP-2 expression compared to the control group. The use of ASCs exosome and PRF showed comparable outcomes compared to bone graft administration in terms of histomorphometry analysis. The administration of adipose tissue derived mesenchymal stem cells and PRF has a comparable outcome with the use of bone graft in terms of osseus area and expression of BMP-2 in critical bone defect.

Socioeconomic disparity in transcatheter and surgical aortic valve replacement: a population study of National Inpatient Sample from 2015 to 2020

There is limited data on the effect of socioeconomic status (SES) on transcatheter (TAVR) and surgical aortic valve replacement (SAVR) outcomes for aortic stenosis (AS). This study conducted a population-based analysis to assess the influence of SES on valve replacement outcomes. Patients with AS undergoing TAVR or SAVR were identified in National Inpatient Sample from Q4 2015–2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients living in neighborhoods of income at the lowest and highest quartiles. Of 613,785 AS patients, 9.77% underwent TAVR and 10.13% had SAVR. These rates decline with lower neighborhood income levels, with TAVR/SAVR ratio also declining in lower-income areas. Excluding concomitant procedures, 58,064 patients received isolated TAVR (12,355 low-income and 15,212 high-income) and 43,694 underwent isolated SAVR (10,029 low-income and 10,811 high-income). Low-income patients, in both TAVR and SAVR, were younger but had more comorbid burden. For isolated TAVR, outcomes were similar across income groups. However, for isolated SAVR, low-income patients experienced higher in-hospital mortality (aOR = 1.44, p < 0.01), pulmonary (aOR = 1.13, p = 0.01), and renal complications (aOR = 1.14, p < 0.01). They also had more transfers, longer waits for operations, and extended hospital stays. Lower-income communities had reduced access to TAVR and SAVR, with TAVR accessibility being particularly limited. When given access to TAVR, patients from lower-income neighborhoods had mostly comparable outcomes. However, patients from low-income communities faced worse outcomes in SAVR, possibly due to delays in treatment. Ensuring equitable specialized healthcare resources including expanding TAVR access in economically disadvantaged communities is crucial.

#2139 Non-lupus full house nephropathy: a debatable entity

Abstract Background and Aims The presence of a full house (FH) pattern at immunofluorescence on kidney biopsy in a patient without clinical and laboratory features of systemic lupus erythematosus (SLE) has led to the descriptive term non-lupus full house nephropathy (NLFHN). This systematic review and meta-analysis focus on NLFHN nomenclature, clinical findings and outcomes. Method In a reiterative process, all identified terms for NLFHN and other MeSH terms were searched in PubMed. Out of 344 results, 57 records published between 1982 and 2022 were included in the analysis. Clinical data of single patients from different reports were collected and analysed. Results Out of the 57 records, 61% were case reports. NLFHN was addressed with 17 different names; the same name used by different authors could refer to different entities. We identified 148 patients: 75 (51%) were males; median age 35 (23-58) years. Serum creatinine and proteinuria at onset were 1.4 (0.8-2.5)mg/dL and 5.7 (2.7-8.8)g/day. Overall, about half of patients achieved complete response. A causative agent was identified in 51 (44%) patients, predominantly infections(41%). Secondary NLFHN was mostly non-relapsing with worse kidney function at onset compared to idiopathic NLFHN (P = 0.001). Among the 57 (50%) patients with idiopathic NLFHN, complete response was comparable between patients treated with immunosuppression and supportive therapy; however, proteinuria and creatinine at onset were higher in patients treated with immunosuppression (P = 0.089 and P = 0.066). The remaining 7 (6%) patients developed SLE after a median follow-up of 5.0 (1.9-9.0) years. Conclusion The place of NLFHN among glomerular diseases is still uncertain, due to the lack of high-quality evidence and consensus on nomenclature. NLFHN can be evaluated as initial manifestation of SLE, isolated manifestation of SLE or a new disease unrelated to SLE. Data support the classification of SLE and NLFHN as distinct clinical entities, with comparable outcome. However, RCTs are needed to drive strong conclusions on treatments and outcomes.

#2741 The interplay between donor &amp; recipient factors, outcomes, and transplant artery flow volume as measured by phase-contrast magnetic resonance imaging

Abstract Background and Aims Cardiovascular health and kidney transplant health are inter-connected [1]. Phase-contrast magnetic resonance imaging (PC-MRI) is a non-invasive means of quantifying blood flow volume within vasculature. Its utility for the assessment of blood flow volumes within the transplant renal artery has not been explored. The aims of this study were to determine if: (A) flow in the transplant artery is influenced by donor and recipients factors, (B) flow in the transplant artery is related to or influences clinical outcomes for transplant recipients. Method Analysis of PC-MRI sequences obtained during 218 kidney transplant magnetic resonance angiograms (MRA) performed at a single centre between 2019 and 2021 was undertaken. All scans were clinically indicated and requested by clinicians to investigate for transplant renal artery stenosis (TRAS). Baseline clinical and demographic data and subsequent clinical outcome data were collected for all study participants. Median follow up was 49 (IQR 40–54) months. For Kaplan-Meier survival analyses, comparison of clinical outcomes by interquartile range of flow volumes was performed, whereby quartile one comprised subjects with the lowest transplant artery blood flow volumes. Statistical analysis was performed using MedCalc Statistical Software version 22.013. Results In this study of 218 subjects, 49 (22.4%) had features of possible TRAS identified on initial MRA. TRAS was subsequently confirmed via intra-arterial digital subtraction angiography in 19 (8.7%) cases. The majority of participants were male 150/218 (68.8%). The commonest cause of ESKD was diabetic kidney disease at 71/218 (32.6%). Living donor transplant recipients were 35/218 (11.5%) of the study population. The median donor age was 55 (IQR 44–65) years. The median time from ESKD to transplantation was 25 (IQR 9–53) months. The median time from transplantation to PC-MRI for all participants was 322 (IQR 81–1744) days; for participants who were ultimately diagnosed with TRAS it was 169 (IQR 76–262) days. The median age of recipients at time of PC-MRI was 56 (IQR 45–64) years. Overall, the mean transplant artery flow volume was 0.41 L/min (95% CI 0.39–0.45 L/min). Rank correlation between age of donor and flow in the transplant artery (L/min) showed r = −0.25 (95% CI −0.37 - −0.12) P = 0.0002. Rank correlation between age of recipient at time of PC-MRI and flow in the transplant artery (L/min) showed r = −0.37 (95% CI −0.48 to −0.25) P ≤ 0.0001. Rank correlation between flow in the transplant artery (L/min) and estimated glomerular filtration rate (mL/min/1.73 m2) showed r = 0.43 (95% CI 0.31–0.53) P &amp;lt; 0.0001. Univariable linear regression analysis of flow in the transplant artery (L/min) and estimated glomerular filtration rate (mL/min/1.73 m2) was R2 0.14, DF regression = 1 DF residual = 214, F = 34.7, P &amp;lt; 0.0001 (Fig. 1). Overall, 35 (16.1%) participants experienced kidney transplant failure and 42 (19.3%) participants died within the study follow up period. Kaplan-Meier analysis showed no significant difference in kidney transplant survival between four groups categorized according to transplant artery flow volumes, logrank test P = 0.93 (Fig. 2A). Subjects in the first quartile were at greater risk of death, logrank test P = 0.01, HR 4.36 (95% CI 1.77–10.74) compared with fourth quartile (Fig. 2B) Conclusion This study has demonstrated that both older donor age and older recipient age negatively correlate with transplant artery flow, and that transplant artery flow is positively correlated and predicts estimated glomerular filtration rate. Finally, recipients with low transplant artery flow volume are at greater risk of death. Neither cause nor effect of low blood flow volume have been elucidated in this study. However, improving transplant blood flow by optimising cardiovascular health may have a positive impact on outcomes for people with kidney transplants and warrants further study.

#1259 Relationship between renal dysfunction, non-obstructive ACS and in-hospital prognosis: findings from the CCC-ACS project

Abstract Background and Aims Acute coronary syndrome (ACS) is an acute and critical condition of coronary heart disease (CHD) with high mortality and poor prognosis. The prevalence of non-obstructive ACS is about 5% ∼ 15%. Among patients with non-obstructive ACS, which patients are more prone to poor prognosis is a concern. Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease, and due to its special pathophysiological mechanism, non-obstructive ACS may not be uncommon in CKD patients. Therefore, the aim of this study was to investigate the relationship between renal function, the occurrence and prognosis of non-obstructive ACS. Method Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS), a hospital-based medical quality improvement project, is a hospital-based medical quality improvement project to improve the compliance of ACS guidelines in China and improve the prognosis of patients. It was jointly sponsored by the American Heart Association (AHA) and the Chinese Society of Cardiology (CSC) in 2014, with 240 hospitals participating, representing different levels of ACS management in Chinese hospitals. We analyzed patients who underwent coronary angiography from November 2014 to July 2019 in CCC-ACS. Patients were divided into eGFR &amp;lt;60 ml/min·1.73 m² and eGFR≥60 ml/min·1.73 m² groups according to estimated glomerular filtration rate (eGFR) calculated by the EPI formula. According to the results of coronary angiography, the patients were divided into obstructive ACS group and non-obstructive ACS group (obstructive ACS group was defined as at least one coronary artery stenosis ≥ 50%; the others were non-obstructive ACS group). Outcome was defined as in-hospital all-cause mortality and in-hospital MACEs. Results A total of 77 586 patients were included, including 2 292 patients (3.0%) with non-obstructive ACS and 75 294 patients (97.0%) with obstructive ACS. After adjusting for confounding factors using a multivariate logistic regression model, patients with eGFR&amp;lt;60 ml/min·1.73 m² had an approximately 20% increased risk of non-obstructive ACS compared with patients with eGFR≥60 ml/min·1.73 m². The comparison of in-hospital outcomes between the patients with non-obstructive ACS and obstructive ACS is shown in Fig. 1. In-hospital outcomes showed that although the obstructive ACS group had a worse in-hospital prognosis than the non-obstructive ACS group, and the eGFR&amp;lt;60 ml/min·1.73 m² group had a worse in-hospital prognosis than the eGFR≥60 ml/min·1.73 m² group, further grouping of patients showed that the non-obstructive ACS group with eGFR&amp;lt;60 ml/min·1.73 m² had a worse prognosis than the obstructive ACS group with eGFR≥60 ml/min·1.73 m². Confounding factors adjusted for non-obstructive ACS showed that lower eGFR was associated with a higher risk of in-hospital MACEs. After analyzing the in-hospital medication and discharge medication of patients, it was found that the standardized cardiovascular drug therapy was inadequate in patients with non-obstructive ACS. Conclusion Patients with non-obstructive ACS have worse renal function than patients with obstructive ACS, and the proportion of patients with eGFR&amp;lt;60 ml/min·1.73 m² is higher. In patients with non-obstructive ACS, the risk of in-hospital MACEs significantly increased as eGFR decreased. This suggests that we may consider giving standardized cardiovascular drug therapy to patients with non-obstructive ACS, especially those with non-obstructive ACS combined with abnormal renal function, in order to improve the prognosis of patients. This needs to be confirmed by more randomized controlled trial results.

Comparison of Complications and Visual Outcomes of Combined Phacovitrectomy versus Standalone Phacoemulsification: A Multicenter Database Study.

To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) to those with standalone phacoemulsification. A multicenter database study across 8 ophthalmology departments in the United Kingdom. Retrospective, nonrandomized, multicenter comparative study. We extracted data for patients who underwent Phaco-PPV and standalone phacoemulsification from January 2000 through May 2015. The primary study outcomes were the rates of intraoperative complications and CME after surgery. The study included 2222 eyes in the combined Phaco-PPV group and 112689 in the standalone phacoemulsification group. The combined Phaco-PPV group had a higher incidence of posterior capsule rupture (2.7% vs. 1.7%), dropped lens fragments (0.5% vs. 0.2%), suprachoroidal hemorrhage (0.4% vs. 0.1%), and cystoid macular edema (3.6 vs. 1.1%) (P<0.001). The mean preoperative visual acuity (VA) was lower in the combined Phaco-PPV group, with a mean VA of 0.98 vs 0.68 logMAR (Snellen ∼20/200 vs. 20/100) in the standalone phacoemulsification group (P<0.001). Visual acuity at 24 weeks was lower in the combined Phaco-PPV group (mean VA 0.67 vs. 0.22 logMAR (Snellen ∼20/100 vs. 20/32), P<0.001). Combined Phaco-PPV had higher rates of intraoperative complications and CME, along with a lower postoperative visual acuity when compared to standalone phacoemulsification surgery.

Comparison of Clinical and Radiological Outcomes of Total Knee Arthroplasty in Osteoarthritic Patients.

Background The knee is the joint most commonly affected by osteoarthritis, more than any other. Osteoarthritis is a progressive, long-term condition that leads to the deterioration of joint tissue and cartilage, resulting in pain and impairment. Total knee arthroplasty (TKA) is a successful intervention that improves functional capability, decreases pain, and enhances quality of life. We conducted this study to evaluate whether radiological parameters following TKA influence the clinical outcomes of patients with knee osteoarthritis. Methods The study was conducted on patients treated for knee osteoarthritis at the Department of Orthopedics, Rajindra Hospital and Government Medical College, Patiala, Punjab, in collaboration with the Department of Radiology over a period of 1.5 years. A total of 152 patients diagnosed with knee osteoarthritis were included in the study; all underwent TKA. Patients underwent clinical evaluation and were graded using the Knee Society Score (KSS) during follow-up examinations. Pain was evaluated using the Visual Analog Scale (VAS). Postoperative X-rays were obtained, and various angles, including the distal femoral angle (DFA), the proximal tibial angle (PTA), and the posterior slope angle (PSA), were measured. Patient follow-up was conducted at three days, three months, and six months. Subsequently, a comparison of the clinical and radiological outcomes of TKA was performed. Results In this study, a total of 152 patients participated, with the majority falling into the 61-70 age group. Of these patients, 40.13% were female and 59.87% were male. The average medial DFA was 94.05°, the average medial PTA was 89.31°, and the PSA was 6.6°. Patients with a medial DFA of 94.05° (±3), a medial PTA of 89.31° (±3), and a PSA of 6.6° (±3) were categorized into the normal group. Conclusion Patients with DFA, PTA, and PSA in the normal range demonstrate improved KSS and clinical outcomes.

The Development of a European Multidisciplinary Cleft Lip and Palate Registry by the European Reference Network CRANIO: Experiences, Barriers, And Facilitators.

The European Reference Network for Rare Craniofacial Aanomalies and Ear-Nose-Throat disorders aims to improve care for patients with such afflictions, including cleft lip and palate (CL/P) across Europe. Cleft treatment remains varied throughout European centers, inhibiting meaningful comparison of treatment outcomes. To overcome these issues, a European-wide common CL/P dataset and registry was developed, facilitating standardized treatment endpoints and outcome measures for international comparison and benchmarking of CL/P centers. Questionnaires and semi-structured interviews were used to determine the set-up of the registry. Previous CL/P initiatives were analyzed to create an initial dataset, refined through consensus meetings. In total, 87 cleft specialists working in specialized CL/P centers from 16 European nations participated. Consensus on a common dataset was reached. A "Level 1" dataset, with mandatory clinical and patient-reported outcome measures, and "Level 2" dataset with additional outcome measures. Finally, 2 dashboards were developed for data dissemination. The development of the European CL/P common dataset and registry tackled challenges with resource disparities, variations in specialists within CL/P teams, regulatory differences in patient data usage, patient-reported outcome measures availability in European languages, and use of assessment tools. This study described the successful development of the European Reference Network for Rare Craniofacial Aanomalies and Ear-Nose-Throat disorders CL/P common dataset and registry. This achievement will help improve patient care and outcomes for patients with CL/P in Europe. Furthermore, this study provides useful information for initiatives with similar aims.

The impact of the new ESTRO-ACROP target volume delineation guidelines for postmastectomy radiotherapy after implant-based breast reconstruction on breast complications

The European Society for Radiotherapy and Oncology–Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) updated a new target volume delineation guideline for postmastectomy radiotherapy (PMRT) after implant-based reconstruction. This study aimed to evaluate the impact on breast complications with the new guideline compared to the conventional guidelines. In total, 308 patients who underwent PMRT after tissue expander or permanent implant insertion from 2016 to 2021 were included; 184 received PMRT by the new ESTRO-ACROP target delineation (ESTRO-T), and 124 by conventional target delineation (CONV-T). The endpoints were major breast complications (infection, necrosis, dehiscence, capsular contracture, animation deformity, and rupture) requiring re-operation or re-hospitalization and any grade ≥2 breast complications. With a median follow-up of 36.4 months, the cumulative incidence rates of major breast complications at 1, 2, and 3 years were 6.6%, 10.3%, and 12.6% in the ESTRO-T group, and 9.7%, 15.4%, and 16.3% in the CONV-T group; it did not show a significant difference between the groups (p = 0.56). In multivariable analyses, target delineation is not associated with the major complications (sHR = 0.87; p = 0.77). There was no significant difference in any breast complications (3-year incidence, 18.9% vs. 23.3%, respectively; p = 0.56). Symptomatic RT-induced pneumonitis was developed in six (3.2%) and three (2.4%) patients, respectively. One local recurrence occurred in the ESTRO-T group, which was within the ESTRO-target volume. The new ESTRO-ACROP target volume guideline did not demonstrate significant differences in major or any breast complications, although it showed a tendency of reduced complication risks. As the dosimetric benefits of normal organs and comparable oncologic outcomes have been reported, further analyses with long-term follow-up are necessary to evaluate whether it could be connected to better clinical outcomes.

Transforming health care: Investigating Influenzer, a novel telemedicine-supported early discharge program for patients with lower respiratory tract infection: A non-randomized feasibility study.

The COVID-19 pandemic has posed unprecedented challenges to healthcare systems globally, necessitating innovative care models like hospital-at-home and virtual care programs. The Influenzer telemedicine program aims to deliver hospital-led monitoring and treatment to patients at home. Integrating telemedicine technology with domestic visits provides an alternative to traditional hospitalization, with the aim of easing the burden on healthcare facilities without compromising patient safety. To evaluate the effectiveness of the Influenzer program, a randomized controlled trial is proposed. This study aimed to assess the feasibility of the proposed clinical trial design. A non-randomized feasibility study was conducted at the Department of Pulmonary and Infectious Diseases at Nordsjaellands Hospital offering a telemedicine-supported early discharge program to patients with lower respiratory tract infections, including COVID-19. The feasibility of trial procedures, including recruitment, adherence, and retention, was analyzed. Also, participants' characteristics and trajectory during the intervention, including telemedicine and domestic services, were assessed. Nineteen patients were enrolled from June 2022 to April 2023 and treated at home. Forty patients were not enrolled as 15 (25%) were non-eligible according to study protocol, 15 (25%) refused to participate and 10 (17%) had not been approached. Subjects treated at home had comparable clinical outcomes to those treated in the acute hospital, no major safety incidences occurred and patients were highly satisfied. Participants demonstrated 99% adherence to planned daily monitoring activities. In total, 63% completed all survey assessments at least partially including baseline, at discharge, and 3 months post-discharge, while 89% participated in a follow-up interview. No participants withdrew their consent. The feasibility study documented that the Influenzer home-hospital program was feasible and well accepted in a Scandinavian setting in terms of no withdrawals and excellent participant adherence to the planned daily monitoring activities. Challenges in the organizational structures including patient recruitment and data collection required resolution prior to our randomized clinical trial. Insights from this feasibility study have led to the improved design of the final Influenzer program evaluation trial. ClinicalTrials.gov, NCT05087082. Registered on 18 August 2021.

#665 Comparison of outcomes between kidney transplant-naïve and post-transplant graft failure peritoneal dialysis patients

Abstract Background and Aims Despite progress in kidney transplant medicine, there are still patients experiencing graft failure and returning to dialysis therapy. Data regarding the prognosis of these patients remain conflicting. This study was conducted to compare clinical outcomes between transplant-naïve peritoneal dialysis (PD) patients and those returning to PD after a failed allograft. Method In this retrospective cohort study during 2006 and 2016, we included a total of 786 patients on chronic PD. Of them 679 were transplant-naïve, 76 patients underwent a successful transplantation, and 32 patients returned to PD after a failed kidney allograft. Baseline demographics and clinical characteristics were analyzed in relation to the outcomes of all-cause mortality and peritonitis rate. We employed the Kaplan-Meier method and Cox proportional hazards model to evaluate survival, while Poisson regression was utilized to estimate rate ratios for peritonitis. Results During a median follow-up of 6.37 years, 56.68 % death and 146.62 episodes of peritonitis/patient-year were observed. Compared with patients who received a kidney graft, transplant-naïve patients were older, more with diabetes and having higher mortality (58.6 ± 15.8, 40.5% and 57.73%, p &amp;lt; 0.0001). After accounting for age, gender, and comorbidities, the adjusted hazards ratios were 0.26 (95% CI 0.13-0.53) in patients with a functioning graft and 1.12 (95% CI 0.61-2.06) in patients returning to PD after graft failure, compared respectively with concurrent PD patients without kidney transplant. The adjusted relative risk of peritonitis in patients resuming PD after graft failure was comparable to those without kidney transplant (95% CI 0.22-1.14). Conclusion Successful kidney transplant reduced the risk of overall mortality among patients on long-term PD. Patients returning to PD after graft loss showed outcomes similar to transplant-naïve counterparts. These data support reactivation of PD as a viable option for patients with a failed kidney transplant.

#1804 Long-term outcomes of CKD patients with lupus nephritis: a nationwide cohort study

Abstract Background and Aims Health trajectories of patients with lupus nephritis (LN) are poorly understood in the setting of moderate and advanced chronic kidney disease (CKD). Furthermore, data on comparison of outcomes of LN to other forms of CKD are scarce. Therefore, the aim of this study was to compare long-term outcomes between LN and CKD from other etiologies. Method Using data from the Swedish Renal Registry (2006-2021), we compared clinical outcomes between patients with moderate and advanced CKD related to LN (LN-CKD), and patients with CKD due to primary glomerular diseases (PGD-CKD, i.e. IgA nephropathy, focal segmental glomerulosclerosis, membranous nephropathy), and due to other common CKD etiologies with high cardiovascular risk (Other-CKD, mostly diabetes and nephrosclerosis). Cox proportional hazard models were used to estimate the adjusted hazard ratios of mortality, major cardiovascular events (MACE), heart failure (HF), kidney replacement therapy (KRT) and acute kidney injury (AKI). Models were adjusted for age, sex, comorbidities, clinical and biological data including kidney function, medications and healthcare utilization. Results At baseline, patients with LN-CKD (N = 317, 61 years, 76% women, median eGFR 30 mL/min per 1.73 m²) and PGD-CKD (N = 2296, 57 years, 30% women, eGFR 29 mL/min per 1.73 m²), were younger and had lower prevalence of cardiovascular disease than patients with Other-CKD (N = 34778, 75 years, 36% women, eGFR 25 mL/min per 1.73 m²). Over a median follow-up of 6.2 [3.3; 9.8] years, 19029 deaths (51%), 15768 (42%) MACE and 8390 (22%) KRT events occurred. The unadjusted 5-year absolute risks of death and MACE were high both in patients with LN-CKD (27% and 25%) and Other-CKD (50% and 44%), but lower in those with PGD-CKD (16% and 14%), whereas the 5-year absolute KRT risk was higher in patients with PGD-CKD (PGD-CKD: 37%, LN-CKD: 23%, Other-CKD: 23%). In multivariable analyses and as compared to PGD-CKD, patients with LN-CKD had a higher risk of death (adjusted HR: 1.63 [95% CI: 1.32-2.02]), MACE (1.65 [1.31-2.08]), HF (1.68 [1.31-2.14]) and AKI (1.45 [1.02-2.05]) and showed a lower risk of KRT (HR: 0.81 [0.64-1.02]), although the 95% CI slightly overlapped (Figure, panel A). In contrast, the risks of adverse events were similar between patients with LN-CKD and those with Other-CKD (Figure, panel B). Conclusion While LN-CKD had a lower risk of KRT than PGD-CKD, they exhibited a higher risk of death, MACE, KRT, HF and AKI, reaching the risk magnitude of patients with high cardiovascular burden (Other-CKD). Our findings may inform decisions for care planning in patients with advanced CKD and LN.

Segregation test—a standardisable test for suffusion assessment of granular soils

Suffusion is arguably the most complicated type of internal erosion. Although there are several popular assessment methods, the most realiable assessment is possibly still laboratory testing. However, there is not a standardised test for suffusion yet as different laboratories use different equipment and test configurations. Hence, a reliable comparison of outcomes across laboratories may not be able to achieve yet. This paper presents a new and simple, but very effective, way to test the susceptibility of soil to internal erosion using a novel segregation test. The test employs standard equipment which can be easily found in any geotechnical laboratory. There are some common characteristics of internal erosion and transport segregation, where fine particles are transported through the pore constrictions formed by the soil’s primary fabric. In segregation, particles are transported by gravitational/mechanical force to the bottom of the soil mass. Meanwhile, they are washed out of the soil mass by hydraulic force in internal erosion. Laboratory testing for internal erosion often requires specific equipment and a long duration. Meanwhile, segregation test could be undertaken with standardised sieving tower, which is available in any geotechnical laboratory. The approach was verified with an acrylic setup and some 3D-printed details. Later, the tests of 25 mixtures were undertaken with standard sieving sets. The correlation of laboratory results shows good agreement and prompts the common application of the new approach. The new test may not be able to completely replace the conventional suffusion test yet as it overlooks the critical hydraulic gradients at this stage, but it can be very useful if the research focuses on only the erodible mass and susceptibility to suffusion. In addition, it is a standardisable test with no specific requirements on equipment. The new approach may also be a starting point to study other types of internal erosion.

Neonatal morbidity and mortality in birth centers in the United States 2018-2021: An observational study of low-risk birthing individuals.

Many studies reporting neonatal outcomes in birth centers include births with risk factors not acceptable for birth center care using the evidence-based CABC criteria. Accurate comparisons of outcomes by birth setting for low-risk patients are needed. Data from the public Natality Detailed File from 2018 to 2021 were used. Logistic regression, including adjusted and unadjusted odds ratios, compared neonatal outcomes (chorioamnionitis, Apgar scores, resuscitation, intensive care, seizures, and death) between centers and hospitals. Covariates included maternal diabetes, body mass index, age, parity, and demographic characteristics. The sample included 8,738,711 births (8,698,432 (99.53%) in hospitals and 40,279 (0.46%) in birth centers). There were no significant differences in neonatal deaths (aOR 1.037; 95% CI [0.515, 2.088]; p-value 0.918) or seizures (aOR 0.666; 95% CI [0.315, 1.411]; p-value 0.289). Measures of morbidity either not significantly different or less likely to occur in birth centers compared to hospitals included chorioamnionitis (aOR 0.032; 95% CI [0.020, 0.052]; p-value < 0.001), Apgar score < 4 (aOR 0.814, 95% CI [0.638, 1.039], p-value 0.099), Apgar score < 7 (aOR 1.075, 95% CI [0.979, 1.180], p-value 0.130), ventilation >6 h (aOR 0.349; [0.281,0.433], p-value < 0.001), and intensive care admission (aOR 0.356; 95% CI [0.328, 0.386], p-value < 0.001). Birth centers had higher odds of assisted neonatal ventilation for <6 h as compared to hospitals (aOR 1.373; 95% CI [1.293, 1.457], p-value < 0.001). Neonatal deaths and seizures were not significantly different between freestanding birth centers and hospitals. Chorioamnionitis, Apgar scores < 4, and intensive care admission were less likely to occur in birth centers.

#1216 Comparable outcomes for old, older and very old deceased donors in old kidney transplant recipients

Abstract Background and Aims Old patients (≥ 65 years) make up almost 1/3 of the waiting list for kidney transplantation in the Netherlands, and this proportion continues to rise. These patients have a high waitlist mortality and benefit from early transplantation, even with kidneys from older or ‘marginal’ donors. Transplanting marginal donor kidneys may help to cut the proportion of elderly patients on the waiting list and improve clinical outcomes. More epidemiological support regarding the graft outcomes of old, older and very old donor kidneys is needed to support clinicians in accepting these kidneys. We therefore studied the outcomes of these kidneys in old recipients. Method Retrospective cohort study of all kidney transplant recipients ≥ 65 years with a deceased donor ≥ 65 years in the Netherlands between 2005 and 2022. Discarded kidneys from deceased donors ≥ 65 years in the same time period were included as well. Donors were categorized into old (65-69 years, OD), older (70-74, OD+) and very old (75+, OD++). Results We included 1301 transplantations from donors ≥ 65 years, of which 435 from an OD+ and 90 from an OD++. Median recipient age was 69 years (66 - 72), 67% was male. The transplanted OD+ and OD++ kidneys were more often from DBD donors (OD 42%, OD+ 51.3%, OD++ 70%, P &amp;lt; 0.01) with lower nadir creatinine compared to the OD kidneys (61.0 umol/l [51.0, 74.0] vs. OD+ 59.0 [49.0, 72.0] P = .034, vs OD++ 58.0 [49.0, 64.5] P = .021). Patient survival was similar for recipients of OD, OD+ and OD++ kidneys at one year (91% vs 89% vs 93%, respectively; Plog-rank = 0.3) and at five years (60% vs 60% vs 64%; Plog-rank = 0.2) after transplantation. Additionally, in multivariable Cox regression, donor age category was not associated with recipient mortality risk (Ref = OD. OD+: P = .7; OD++: P = .2). Death-censored graft survival was ≥92% in all groups after 1 year, and did not differ significantly between donor age categories (PGray's = 0.2). Results remained non-significant in multivariate Cox regression (Ref = OD, OD+: P = .942; OD++: p = 0.403). Kidneys offered but not accepted for transplantation (before procurement) had a higher serum nadir creatinine in comparison with transplanted kidneys (68 umol/L [56 - 84] vs 61 umol/L [51 - 78], P &amp;lt; .001), and were more often from DCD donors (79% vs 53%, P &amp;lt; .001). However, donor characteristics of many discarded kidneys resembled that of successfully transplanted kidneys. Conclusion Recipient and graft survival are good and similar for old patients receiving kidneys from old, older and very old deceased donors. These findings may contribute to a wider acceptance of kidneys from these donors.

#2528 Comparing patient-reported and performance-based physical function assessments in hemodialysis: insights from the CONVINCE trial

Abstract Background and Aims Physical function is a crucial outcome in nephrology. In alignment with the Patient-Reported Outcomes Measurement Information System (PROMIS) Initiative, physical function is characterized as the ability to execute activities involving physical actions, ranging from self-care to more complex activities, such as social activities. This definition of physical function spans various domains of the International Classification of Functioning, Health, and Disability (ICF). The assessment of physical function commonly employs two distinct approaches, patient-reported outcomes (PRO) and observed performance outcomes (PerfO). PRO and PerfO assessments have distinct advantages and limitations and were found to correlate only moderately, adding complexity to cross-instrument outcome comparisons and interpretation. Despite this, there is limited understanding of the factors contributing to the discordance between PRO and PerfO assessments in patients with kidney disease. In this study, we applied a previously established common T-score metric for patient-reported and performance-based physical function to compare patterns of associations with potential laboratory-based, psychosocial, sociodemographic, and health-related determinants in hemodialysis patients. Method Cross-sectional data from the baseline assessment of the CONVINCE trial (N = 1,132), a multinational randomized controlled trial comparing high-dose hemodiafiltration with high-flux hemodialysis, were analysed. To investigate the relationships between potential determinants and performance-based versus patient-reported physical function, we performed multiple linear regression analysis. Dependent variables were standardized T-scores derived from the PROMIS physical function short-form 4a (PRO) and the Physical Performance Test (PerfO). Both measures assess a generic concept of physical function. We compared the effect sizes of each potential determinant in the multiple regression model using partial f2 values, with thresholds of 0.02, 0.15, and 0.35 denoting small, medium, and large effects. Results Both, PerfO and PRO exhibited significant associations with a laboratory marker-based indicator of muscle mass (simplified creatinine index), albeit with relatively small effects (partial f² of 0.04 and 0.05, respectively). None of the other laboratory measures investigated in this study showed any relevant associations with physical functioning. Age demonstrated a negative association with physical function, with a larger effect size observed for performance-based (partial f² = 0.11) compared to patient-reported physical function (partial f² = 0.04). In contrast to performance-based physical function, patient-reported physical function displayed a stronger association with self-reported health domains, particularly pain interference and fatigue. Exploring the differences between patient-reported and performance-based T-scores at the individual level, we found that younger age and more cognitive/emotional fatigue were associated with lower patient-reported compared to performance-based physical function (small effect sizes). Conclusion PRO and PerfO assessments of physical function in hemodialysis patients had similar associations with the simplified creatinine index, suggesting comparable links to objective physical impairment. However, PRO-based physical function exhibited a notably stronger association with other patient-reported variables, suggesting that patient-reported constructs of physical function might represent more than just capability, but ‘capability free from symptomatic constraints’. This distinction should be taken into account when directly comparing or aggregating PRO and PerfO scores. A noteworthy aspect of our study is the utilization of a common T-score metric for both PRO and PerfO measures. This method enhances interpretability of results and facilitates comparisons across diverse assessment types, thereby offering valuable insights into the determinants of physical function in patients undergoing hemodialysis.

Trichiasis in cicatricial ocular surface disease: a multi-center comparison of electroepilation versus eyelash resection outcomes

ABSTRACT Purpose To evaluate the outcomes of trichiasis (excluding entropion) management in non-trachomatous cicatricial ocular surface diseases. Methods This is a multicenter, retrospective study of 59 patients with trichiasis who were managed using two different techniques: electroepilation using radiofrequency (RF) cautery and eyelash resection. The assessed outcomes were residual trichiasis at 6 weeks, 6, and 12 months of follow-up and the number of procedures needed. Results 41 patients (90 eyelids) underwent electroepilation, and 18 (41 eyelids) were managed with eyelash resection. All patients belonged to either Indian or Japanese ethnicity. Most patients in both groups had Stevens-Johnson Syndrome (63.4% vs. 88.9%). The mean age (43.2 vs. 46 years), disease duration (122 vs. 192.4 months), median trichiasis grade (2 vs. 2), and involvement of upper eyelids (53/90 vs. 23/41) were similar in the two groups. At six weeks, 48.9% of eyelids that underwent electroepilation had no trichiasis, and recurrences were managed with repeat electroepilation (6 eyelids) and mucous membrane grafting (10 eyelids), and 35 eyelids opted for manual epilation, giving 67.8% success at a mean follow-up of 20 months. The eyelash resection group had 75.6% success at 6 months, and recurrences were managed using lid splitting and eyelash resection, resulting in 100% success at a mean follow-up of 79 months. More interventions were needed in the electroepilation group compared to eyelash resection. Conclusion Eyelash resection of the trichiatic eyelashes achieves a better success rate than electroepilation in cicatricial ocular surface disorders. Following electroepilation, one needs multiple interventions to resolve trichiasis.

Descemet membrane endothelial keratoplasty and penetrating keratoplasty in pseudophakic bullous keratopathy: comparison of visual outcomes, graft survival rates, and complications

Objective: To compare the outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) and Penetrating Keratoplasty (PK) in patients with pseudophakic bullous keratopathy (PBK). Methods: Records of 51 eyes of 51 PBK patients (32 male, 19 female) who underwent PK (Group1=38 eyes) and DMEK (Group 2=13 eyes) were reviewed retrospectively. The two groups were compared for Best-corrected visual acuity (BCVA), graft survival rates, and complications. Results: The mean age was 69.1 and 67.1 years in group 1 and group 2, respectively. First-year cumulative survival rates for group 1 and group 2 were 92.1% and 61.5%, respectively, and 89.1% and 51.3% in the second year (P=0.001 by log-rank test). At the last follow-up visit, 2.7% of Group 1 and 30.8% of Group 2 had a BCVA of 0.3 or better (P=0.004). Graft failure was observed in 12 eyes (31.6%) in group 1 and 8 eyes (61.5%) in group 2 (P=0.056). At the last examination, the rates of transparent grafts were 73.7% and 69.2% in group 1 and group 2, respectively (P=0.756). Postoperative glaucoma was observed in 4 eyes (30.8%) in the group 2 and 4 eyes (10.5%) in the group 1 (P=0.083). There was no significant difference between the two groups regarding other complications (P&gt;0.05). Conclusions: DMEK surgery offers a better visual outcome than PK for the treatment of PBK. Careful follow-up of patients is required in terms of glaucoma and graft failure after DMEK. Although the graft survival rate was lower in the DMEK group, a similar rate of graft transparency was achieved at the final examination with repeated DMEK surgery.