Mean SF Research Articles

Physiologically based trimester-specific serum ferritin thresholds for iron deficiency in US pregnant women

AbstractSerum ferritin (SF) concentration is the most widely used indicator for iron deficiency (ID). During pregnancy, the World Health Organization recently recommended SF thresholds for ID of <15 μg/L for the first trimester of pregnancy, based on expert opinion, and made no recommendations for the second and third trimesters. We examined the relationship of SF with 2 independent indicators of the onset of iron-deficient erythropoiesis, hemoglobin and soluble transferrin receptor 1, in cross-sectional data from US National Health and Nutrition Examination Survey for 1999 to 2010 and 2015 to 2018. We included 1288 pregnant women aged 15 to 49 years and excluded women with inflammation or potential liver disease. We used restricted cubic spline (RCS) regression analysis to determine SF thresholds for iron-deficient erythropoiesis. SF decreased during pregnancy; geometric mean SF was higher during the first and lower during the second and third trimesters. Using RCS analysis, the SF thresholds identified during pregnancy were <25.8 μg/L (18.1-28.5) during first trimester, <18.3 μg/L (16.3-22.9) during second trimester, and <19.0 μg/L (14.4- 26.1) during third trimester. These SF threshold levels track concentrations of hepcidin, the iron-regulatory hormone controlling the mobilization of iron stores. An SF concentration of <15 μg/L as the criterion for ID may underestimate the true prevalence of ID throughout pregnancy. In our study, an additional 1 of every 10 pregnant women would be recognized as iron deficient by using the physiologically based thresholds at SF of ∼25 μg/L during the first and ∼20 μg/L during the second and third trimesters.

Hemodynamic, Oxygenation and Lymphocyte Parameters Predict COVID-19 Mortality.

The mortality of COVID-19 patients has left the world devastated. Many scoring systems have been developed to predict the mortality of COVID-19 patients, but several scoring components cannot be carried out in limited health facilities. Herein, the authors attempted to create a new and easy scoring system involving mean arterial pressure (MAP), PF Ratio, or SF ratio-respiration rate (SF Ratio-R), and lymphocyte absolute, which were abbreviated as MPL or MSLR functioning, as a predictive scoring system for mortality within 30 days for COVID-19 patients. Of 132 patients with COVID-19 hospitalized between March and November 2021, we followed up on 96 patients. We present bivariate and multivariate analyses as well as the area under the curve (AUC) and Kaplan-Meier charts. From 96 patients, we obtained an MPL score of 3 points: MAP < 75 mmHg, PF Ratio < 200, and lymphocyte absolute < 1500/µL, whereas the MSLR score was 6 points: MAP < 75 mmHg, SF Ratio < 200, lymphocyte absolute < 1500/µL, and respiration rate 24/min. The MPL cut-off point is 2, while the MSLR is 4. MPL and MSLR have the same sensitivity (79.1%) and specificity (75.5%). The AUC value of MPL vs. MSLR was 0.802 vs. 0.807. The MPL ≥ 2 and MSLR ≥ 4 revealed similar predictions for survival within 30 days (p < 0.05). Conclusion: MPL and MSLR scores are potential predictors of mortality in COVID-19 patients within 30 days in a resource-limited country.

Iron Status and Associated Factors among Canadian Women: Results from the Canadian Health Measures Survey

BackgroundIron deficiency and overload may negatively impact women’s health. There has been limited assessment of iron status and its associated factors among Canadian women. ObjectivesThis study investigated associations of various sociodemographic, lifestyle, medication, and dietary factors with body iron stores among pre- and postmenopausal women in Canada. MethodsAnalyses were conducted using cross-sectional, nationally representative survey and biomarker data from women aged 20–79 y (n = 6362) in the Canadian Health Measures Survey (2009–2017). Body iron stores were assessed by measuring serum concentrations of ferritin (SF). Information on potential correlates was collected during an in-home interview. Multivariable linear regression analyses were performed to evaluate associations with SF concentration, and logistic regression was used to estimate associations with iron deficiency (SF <15 μg/L) or elevated iron stores (SF >150 μg/L). ResultsGeometric mean SF concentrations were significantly higher in postmenopausal than in premenopausal women (73.2 versus 33.8 μg/L; P < 0.001). The prevalence of iron deficiency among pre- and postmenopausal women was 16.0% and 4.0%, respectively, whereas that of elevated iron stores was 2.7% and 21.0%, respectively. After simultaneous adjustment for multiple factors, including high-sensitivity CRP (inflammation marker), we found that age, East/Southeast Asian (versus White) race/ethnicity, alcohol, and red meat consumption were positively associated with SF concentration among pre- and postmenopausal women. In addition, aspirin use and dairy consumption were inversely associated with SF concentration among postmenopausal women only. Similar patterns were observed for associations with elevated iron stores among postmenopausal women, whereas higher grain consumption was associated with an increased prevalence of iron deficiency among premenopausal women. ConclusionsSociodemographic, lifestyle, medication, and dietary factors are correlated with iron status determined by SF concentration among Canadian women. The findings may have implications for intervention strategies aimed at optimizing body iron stores in pre- and postmenopausal women.

Correlation between overactive bladder and detrusor overactivity: a retrospective study.

The primary objective of this study is to determine the prevalence of overactive bladder (OAB) and detrusor overactivity (DO) in female patients who were referred for urodynamic study (UDS) because of lower urinary tract symptoms (LUTS). The secondary objective is to determine the subjective and objective differences between female OAB patients with and without DO. All female patients who underwent UDS for LUTS between June 2016 and September 2019 were retrospectively reviewed. Personal history, medical history, physical examination, and validated questionnaires were collected. One-hour pad test and multichannel urodynamic study was performed. All statistical analyses were conducted by SAS 9.4. P-value < 0.05 was considered statistically significant. A total of 4184 female patients underwent UDS because of LUTS between June 2016 and September 2019; 1524 patients were analyzed for OAB or DO. The occurrence of OAB was 36.4%. The overall incidence of DO in OAB patients was 15.5%; 9.5% of all patients had DO findings on UDS, and 4.6% were incidental findings. There were significant differences among mean age, parity, ICIQ-UI SF, OABSS, POPDI-6, and all UDS parameters (except for maximal urethral pressure and pressure transmission ratio) between patients with and without DO. In patients with DO, there were no significant differences among age, parity, and BMI with or without OAB symptoms. However, there were significant differences among mean OABSS, ICIQ-UI SF, UDI-6, POPDI-6, IIQ-7, and pad test. Patients with DO are associated with older age, increased parity, greater urine leakage, and worse storage and micturition functions on UDS. Combinations of subjective and objective measurements are better predictive models for OAB patients.

SPINAL DEFORMITY INDEX AND QUALITY OF LIFE OF PATIENTS WITH A DENSITOMETRIC DIAGNOSIS OF OSTEOPOROSIS

ABSTRACT Objective: To evaluate the existence of a possible significant correlation between the quality of life of outpatients with osteoporosis and the Spinal Deformity Index (SDI), a radiographic method for semiquantitative assessment of the spine that enables the identification of prevalent and incident fractures. Methods: A cross-sectional observational study carried out with female patients, Caucasians, over 50 years of age, with a densitometric diagnosis of osteoporosis and in an outpatient follow-up, who were submitted to the Oswestry Disability Index (ODI) and SF-36 questionnaires to measure the direct and indirect damage of vertebral fragility fractures on quality of life. The scores obtained in these questionnaires were correlated with the SDI scores, calculated from the radiographs of the lumbar and thoracic spine. Results: 48 patients completed the study, with a mean age of 69.6±6.7 years, mean body mass index (BMI) of 25.4±3.4 kg/m2, mean ODI of 25.1±17.9%, mean SF- 36 of 428.7±192.4 and mean SDI of 4.3±3. For the statistical analysis, Spearman's coefficient was used (p ≤ 0.05). Conclusion: There is no statistically significant correlation between the SDI and the scores obtained on the ODI and SF-36 quality of life questionnaires. Level of evidence: III. Study of non-consecutive patients, without gold standard, applied uniformly.

MO865SEX HORMONAL PROFILE OF PATIENTS ON MAINTENANCE HEMODIALYSIS AND CORRELATION WITH QUALITY OF LIFE AND DEPRESSION: A CROSS-SECTIONAL STUDY FROM SOUTH INDIA

Abstract Background and Aims Hormonal abnormalities in haemodialysis (HD) patients contribute to quality of life including sexual dysfunction. Whereas Short Form 36 (SF 36) questionnaire deals with the holistic assessment of the quality of life in patients, it is directly impacted by sexual dysfunction or erectile dysfunction in males. In this study we assessed the sex hormone levels in HD patients and its correlation with quality of life (QOL). Method In this single center cross-sectional study, 100 patients (50 males and 50 females) on maintenance HD for more than 6 months were included in the study. In female patients’ sex hormones that included Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Prolactin, Estrogen, Progesterone was assessed in midweek early morning blood sample. In male patients LH, FSH and Testosterone were assessed in midweek early morning samples. QOL assessment was done using SF 36 questionnaire. Results Mean age of our study populations was 33.76+/- 7.86 years with male female ratio of 1:1 and mean body mass index of 20.52 ± 2.89 kg/m2. Presumed chronic interstitial nephritis in was the most common cause of end-stage renal disease (76%) in our study followed by Diabetic Kidney disease (21%). In males, mean serum LH, FSH and Testosterone were 8.58 ± 3.56 mIU/ml, 8.9 ± 4.05, 217.46 ± 96.44 ng/dl respectively with 70% patients having testosterone deficiency. In females, mean serum LH, FSH, Prolactin, estrogen and Progesterone levels were 8.61± 3.86 mIU/ml, 8.08 ± 3.70 mIU/ml, 12.35 ± 5.70 ng/ml, 84.56 ± 27.39 pg/ml and 0.31 ± 0.22ng/ml respectively. Mean SF 36 score in our study was 55.37+/-12.22, in males 54.82+/-12.81 and in females 55.93+/-11.70. The prevalence depression was 53% (50% in males and 56% in females) in our study. There was no significant correlation between SF 36 scores and Beck depression inventory (BDI) scores with LH, FSH in both the genders. In males there was positive correlation between SF 36 scores and testosterone level (r= 0.366), and in females positive correlation between SF 36 score and progesterone level in women HD patients (r= 0.549) was seen. There was a negative correlation between BDI score and progesterone level in women (r=0. -510) and negative correlation between BDI score and testosterone in men (r= -0.371). Conclusion QOL as assessed by SF 36 in patients on HD is low. There was positive correlation between SF 36 scores and testosterone level in males and between SF 36 score and progesterone in females.

The Effect of Gold Nanoparticles on Chemo and Radiotherapy of Brain Tumor Cells

To test the hypothesis that gold nanoparticles (GNPs) can improve the sensitivity of human glioma tumors, to radiotherapy (RT) and chemotherapy. Major objectives were to isolate and culture the human glioma tumor cells in vitro, to evaluate the chemo- & radiosensitizing effects of the GNPs, and to extrapolate this sensitization effect to the isocitrate dehydrogenase (IDH) mutation status of the tumor. Fresh post-operative glioma tumor samples were obtained (n = 43) and cultured in-vitro. Morphology of the cultured cells was evaluated using Giemsa staining and the proliferation index was calculated based on their population doubling time (PDT). Western blot assay was performed to evaluate the expression of apoptotic proteins, viz. Bad, Bax, Caspase-3 and Bcl2, involved in the tumor cell death. Each of such cultured patient samples were then divided into 8 therapeutic interventional groups, i.e. control, GNP alone, Temozolomide (TMZ) alone, TMZ+GNP, RT alone, RT+GNP, RT+TMZ, RT+TMZ+GNP groups. Based on this group assignment, the cultured cells were exposed to the following interventions: carboxylic acid functionalized GNPs of diameter 30 nm at a concentration of 100ng/mL, 6MV energy X-rays to an absorbed dose of 10 Grays (Gy) using Varian linear accelerator and/or to the drug TMZ at the concentration of 500nM. Cell viability and surviving fraction of cells (SF) were assessed 24 hours after the interventions using MTT assay & optical density (OD) value comparisons with the control group (mean SF 100). Study results showed that 36 patients’ samples, cultured successfully in vitro, were evaluable. The RT+TMZ+GNP group was found to have the least mean SF {76.8, (range 50.4 - 92.9)}. The mean (+/- SD) SF in the RT vs RT+GNP group was 88.3 (+/- 11.4) vs 84.5 (+/- 13.3); TMZ vs TMZ+GNP group was 85.1 (+/- 7.2) vs 83.6 (+/- 7.9); and RT+TMZ vs RT+TMZ+GNP group was 77.9 (+/- 12.2) vs 76.8 (+/- 12.4), respectively. Thus, the mean difference in the SF achieved due to addition of GNPs to RT, TMZ, RT+TMZ was 3.79 (p-value 0.001), 1.47 (p-value 0.001), and 1.06 (p-value 0.011), respectively, with statistical significance. More so, this beneficial effect was pronounced in the samples with high proliferation index (HPI) (PDT <72 hrs, n = 13) than in those with low proliferation index (LPI) (PDT >72 hrs, n = 23), with statistical significance. Although the GNPs were found to be advantageous in the IDH positive samples (n = 11) when compared to the IDH negative samples (n = 14), the results were not statistically significant. Apoptosis, a mechanism of tumor cell death, has been confirmed using western blotting technique in our study. Our study is the first to demonstrate that GNPs could potentially be used to enhance the sensitivity of the human glioma tumors to radiotherapy and chemotherapy. Future larger, in vivo studies are needed to confirm our study findings.

Body height in stunted Indonesian children depends directly on parental education and not via a nutrition mediated pathway - Evidence from tracing association chains by St. Nicolas House Analysis.

Background: Multiple linear correlations between parameters can be shown in correlation matrices. Correlations can be ranked, but can also be visualized in network graphs. Yet, translating a correlation matrix into a network graph is not trivial. In view of a popular child game, we propose to name this method St. Nicolas House Analysis. Material and methods: We present a new method (St. Nicolas House Analysis) that helps translating correlation matrices into network graphs. The performance of this and other network reconstruction methods was tested in randomly created virtual scale-free networks, networks consisting of bands or hubs, using balanced classification rate and the F1-Score for correctly predicting existing and non-existing edges. Thereafter we analyzed anthropometric data and information on parental education, obtained from an anthropometric survey in 908 Indonesian boys and 808 Indonesian girls. Seven parameters were analyzed: child height standard deviation score (hSDS), child BMI standard deviation scores (BMI_SDS), mid-upper-arm circumference (MUAC), mean thickness of subscapular and triceps skinfold (mean SF), and elbow breadth; as well as maternal and paternal education (years of schooling). The parameters were considered as the nodes of the network; the edges represent the correlations between the nodes. Results: Performance measures, balanced classification rate and the F1-score, showed that St. Nicolas' House Analysis was superior to methods using sophisticated correlation value thresholds and methods based on partial correlations for analyzing bands and hubs. We applied this method also in an Indonesia data set. Ranking correlations showed the direct association between parental education and child growth. Conclusion: St. Nicolas House Analysis confirmed that growth of Indonesian school children directly depends on maternal education, with no evidence that this effect is mediated by the state of nutrition.

Identifying central serous chorioretinopathy biomarkers in coexisting diabetic retinopathy: a multimodal imaging study

BackgroundTo describe clinical and imaging characteristics of patients presenting with diabetic retinopathy (DR) with coexisting acute or chronic central serous chorioretinopathy (CSCR).MethodsThis was a cross-sectional study which included 54 eyes...

PF504 LONG‐TERM SEQUENTIAL DEFERIPRONE AND DEFERASIROX THERAPY IN TRANSFUSION‐DEPENDENT THALASSEMIA PATIENTS: A PROSPECTIVE CLINICAL TRIAL

Background:Iron overload is the main risk factor for morbidity and mortality in patients (pts) with transfusion dependent thalassemia (TDT). Therefore, life‐long iron chelation therapy is necessary for prevention of morbidities and long‐term survival. Three different chelating agents are currently available to treat iron burden in TDT pts: Deferoxamine (DFO) which is given subcutaneously, and 2 oral agents, Deferasirox (DFX) and Deferiprone (DFP). The possibility of using both oral chelators in a sequential manner remains of interest based on evidence that DFX and DFP have the liver and heart as their main target organ, respectively. Since the sequential administration of both oral chelators in monotherapy could be associated with a lower rate of adverse events (AEs), a prospective clinical trial to study this hypothesis was conducted.Aims:The aim was to assess the safety and effectiveness of the sequential DFP and DFX treatment in TDT pts, as measured by changes in SF, liver and cardiac MRI‐T2∗, over time.Methods:This was a multicenter prospective clinical trial to assess effectiveness and safety of sequential DFP and DFX treatment in TDT pts. Data were collected at the coordinating centre (A.O.V. Cervello, U.O.C. di Ematologia II, Palermo, Italy). A total of 21 consecutive patients were followed at 6 Italian centres between 2010 and 2014. Trial interventions included sequential treatment with oral DFX dispersible tablet at the dose of 30 mg/kg/day for 3 days a week and oral DFP at a dose of 75 mg/kg/day every 6–8 hours for the remaining 4 consecutive days. The planned duration of the study was 5 years. However, since sample size was not reached, it was interrupted on April 10, 2014. Data consisted of repeated measurement on the same patient over time. Linear mixed‐effects (LME) models for repeated measurements were used to assess the effect of the sequential DFX and DFP therapy on SF levels, septum cardiac MRI‐T2∗, and liver MRI‐T2∗ over time.Results:Overall, 21 TDT pts (8 [38.1%] males and 13 [61.9%] females) were enrolled in this trial. Patients’ median age was 32 years (range: 16 to 50). Mean total blood transfusion was 159.2 ± 35.3 ml/kg/year with a mean iron intake of 9.6 ± 0.6 mg/year. The median follow‐up was 32.2 months (range: 1 to 57). Results from the fitted LME model suggested a non‐statistically significant linear increase over time of the mean SF level (Coeff. 0.33 [SE 5.77], 95% CI −10.9 to 11.6, p‐value = 0.954), as shown in Figure 1. The mean values of septum cardiac MRI‐T2∗ was 31.3 ms and 37.3 ms at baseline and at the end of follow‐up, respectively. The estimated results of the LME model for the mean liver T2∗ suggested that there is a statistically signficant linear increase over time (Coeff. 0.13 [SE 0.04], 95% CI 0.05 to 0.21, p‐value = 0.001). Similarly, for the mean septum cardiac MRI‐T2∗, results suggested that there is a statistically signficant linear increase over time (Coeff. 0.22 [SE 0.06], 95% CI 0.09 to 0.33, p‐value&lt; 0.001). None of the patients developed iron overload in the liver or heart during sequential DFX and DFP iron chelation treatment. No moderate/severe adverse events were observed over 36 months.Summary/Conclusion:In our trial, sequential regimen of DFP and DFX maintained SF levels and removed iron from the heart and liver as evident from improvement in MRI‐T2∗ values. None of the pts experienced moderate or severe adverse events. Our data suggest the need to design new and wider studies to check this daily sequential therapy as an effective treatment option in those TDT pts who do not tolerate either mono or combined therapy.image

CRAN-23. QUALITY OF LIFE AND SEXUAL FUNCTIONING IN ADULTHOOD TWO DECADES AFTER PRIMARY GROSS-TOTAL RESECTION FOR CHILDHOOD CRANIOPHARYNGIOMA

Gross-total resection (GTR) of craniopharyngioma is associated with high rates of complications that potentially affect quality of life (QoL). This study investigated the impact of GTR on the long-term QoL and sexual functioning in young adults. 81 pediatric patients treated with primary GTR of craniopharyngioma were included in this retrospective cohort study. The Quality of Life Questionnaire SF36v1 and the Medical Outcomes Study family and sexual functioning scale were used to analyze follow-up data. 22 patients consented and completed the questionnaires. The median time of follow-up was 19 years (range 10–26). 55% of the patients reported to have excellent or very good health in general. The mean SF 36v total score was 51.63 for PCS and 49.26 for MCS. There was no significant difference between the patient cohort and the normal population. Twenty-one out of 22 subjects reported about sexual functioning, of whom 25% of women and 54% of men reported at least ‘a little of a problem’ in one or more areas of sexual functioning. Body mass index (BMI) values were: 14% normal, 41% overweight, 36% obese and 9% morbidly obese. Preoperative hypothalamic involvement and retrochiasmatic location of the tumor was significantly correlated with BMI. Young adults with childhood-onset craniopharyngioma report QoL and sexual functioning similar to that of the normal population. Overweight and obesity are more prevalent in the study population. Retrochiasmatic location of the tumor and hypothalamic involvement on the preoperative imaging correlate with higher BMI in long-term follow-up.

The AES total ankle arthroplasty analysis of failures and survivorship at ten years.

AES mobile-bearing total ankle replacement was developed from the Buechel Pappas model. It was withdrawn in 2009, after identification of a higher than expected complication rate. The purpose of the current study was to analyse clinical outcomes, failures and survival of the initial series of 50 AES published in 2009. In this single-centre continuous prospective study (2003-2006), 50 AES prostheses were included. Pre-operative osteoarthritis was mainly post-traumatic (50%) and secondary to instability (36%). All patients were assessed with clinical and radiographic follow-up at six months, one year, two years and every two to three years thereafter. A CT-scan was systematically performed before procedure, and at two years, five years and ten years. At last follow-up, all patients with TAR had a functional (SF 36, AOFAS) and clinical assessment. All complications or surgical events were analysed. The mean follow-up was ten ± two years (range, 9-13). The mean AOFAS score was 75 points (range, 26-100). The mean SF 36 score was 69 points (range, 35-97). There was a significant deterioration in AOFAS score at five years and at last follow-up (p<0.05). Fifteen TARs underwent reoperation for cyst curettage-graft because of development of periprosthetic lesions. Six of them ended up with prosthesis removal-arthrodesis. At the last follow-up, 14 TARs were removed for arthrodesis. Of the 30 prostheses seen at last follow-up, four are awaiting prosthesis removal-arthrodesis and one for cyst curettage-graft. The ten year survivorships free of any prosthesis removal or arthrodesis and free of any reoperation were 68% (95% CI, 55-85) and 57% (95% CI, 44-74), respectively. Our data suggested a high rate of reoperation. Overall ten year survival was lower than with other designs, particularly due to cyst lesions. Level IV, prospective case series.

Mobile app for treatment of stress urinary incontinence: A randomized controlled trial.

To evaluate the effect of a mobile app treatment for stress urinary incontinence (SUI) in women. Randomized controlled trial, conducted 2013-2014 in Sweden. Community-dwelling adult women with ≥1 SUI episode/week recruited through our website and randomized to app treatment (n = 62) or control group (postponed treatment, n = 61). One participant from each group was lost to follow-up. Intervention was the mobile app Tät® with a treatment program focused on pelvic floor muscle training (PFMT), and information about SUI and lifestyle factors. Primary outcomes, 3 months after randomization: symptom severity (International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form [ICIQ-UI SF]); and condition-specific quality of life (ICIQ Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]). One hundred and twenty-three women were included (mean age 44.7), with moderate/severe SUI (97.5%, 120/123), mean ICIQ-UI SF score 11.1 (SD 2.8) and mean ICIQ-LUTSqol score 34.4 (SD 6.1) at baseline. At follow-up, the app group reported improvements in symptom severity (mean ICIQ-UI SF score reduction: 3.9, 95% confidence interval 3.0-4.7) and condition-specific quality of life (mean ICIQ-LUTSqol score reduction: 4.8, 3.4-6.2) and the groups were significantly different (mean ICIQ-UI SF score difference: -3.2, -4.3to -2.1; mean ICIQ-LUTSqol score difference: -4.6, -7.8 to -1.4). In the app group, 98.4% (60/61) performed PFMT at follow-up, and 41.0% (25/61) performed it daily. The mobile app treatment was effective for women with SUI and yielded clinically relevant improvements. This app may increase access to first-line treatment and adherence to PFMT.

Midterm outcome after surgical correction of anomalous left coronary artery from the pulmonary artery.

BackgroundThis study was undertaken to determine the midterm outcome in patients with anomalous left coronary artery from the pulmonary artery (ALCAPA) undergoing coronary reimplantation and Takeuchi repair.MethodsA retrospective review of patients who had ALCAPA repair between January 2009 and December 2015. Mortality, echocardiography assessment of left ventricular function including ejection fractionand, shortening fraction, severity of mitral regurgitation, stenosis of the coronary ostium were studied retrospectively.ResultsSixteen patients were described. The mean age at the time of surgery was 22.5 ± 10.3 years (range, 9 months-35.6 years) and 2 patients were younger than 1 year old, Surgical interventions included left coronary artery reimplantation in 13 patients (81 %) and Takeuchi repair in 3 (19 %). Concomitant mitral valve repair was performed in 2 cases, no cases required mechanical circulatory support postoperatively. There was no mortality. At median follow-up of 4.6 years, EF improved from 33.2 % ±6.8 % to 60.9 % ± 8.1 % (p <0.05), mean SF from 28.5 % ± 12.1 % to 40.2 % ± 5.4 % (p <0.05). Only one patient was with moderate mitral regurgitation. All 16 cases had normal ejection fraction and shortening fraction without stenosis of the coronary ostium at last follow-up.ConclusionsEarly establishment of a 2-coronary artery achieved excellent outcomes without morbidity and mechanical circulatory support. Normal ejection fraction and shortening fraction recovered smoothly. There is no stenosis of the coronary ostium at the midterm follow-up.

Medial Gastrocnemius Flap for Reconstruction of the Extensor Mechanism of the Knee Following High-Energy Trauma. A minimum 5 year follow-up

IntroductionThe purpose of this study was to assess the medium-term results of reconstruction of the extensor mechanism using the medial gastrocnemius while also providing soft tissue coverage. Materials and methodsThis retrospective review consisted of a consecutive series of four patients (age 28–40 years) with complex high energy traumatic injuries to lower extremity including both soft tissue loss and disruption of the knee extensor mechanism. The medial gastrocnemius rotational flap was used to reconstruct the patellar tendon and restore soft tissue coverage simultaneously. Range of motion and extensor lag; functional recovery was judged by return to work and sports activity. Validated measures included the Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score, and the modified Cincinnati Score. ResultsAt the final follow up was 61.5 (57–66) months after reconstruction, the mean SF 12 physical component score ranged from 21.7 to 56.8 with a median of 55.3; the mental component from 42.8 to 60.7 with a median of 58.6. The KSS knee score ranged from 50 to 78 with a median of 68; the function score from 65 to 90 with a median of 85. The Oxford knee score ranged from 22 to 45 with a median of 33.5. The KOOS ranged from 28 to 82.7 with a median of 73.7 and the modified Cincinnati score from 38 to 82 with a median of 76.5. Knee range of motion ranged from 0 to 120°. Of the four patients three returned to working fulltime in their profession and returned to sports, including mountain biking and fitness training. ConclusionsFor severe traumatic knee injuries with the combination of soft tissue defects and disruption of the extensor mechanism, the medial gastrocnemius flap provides an excellent reconstructive option to address both problems simultaneously. The results of this small case series support the use of this limb salvage technique.

Health-Related Quality of Life Among Patients with Severe Carotid Artery Stenosis / Ar Veselību Saistītās Dzīves Kvalitātes Novērtējums Pacientiem ar Nozīmīgu Miega Artērijas Stenozi

Abstract Information about changes of health-related quality of life (HRQoL) after revascularisation as well how revascularisation procedure influences daily activities, cognitive functioning and general health is controversial. The objectives of our study were to evaluate and describe the HRQoL among patients with severe carotid artery disease; to evaluate the difference of HRQoL between symptomatic and asymptomatic carotid artery disease; and to explore the possible associations between some demographic and clinical characteristics of patients with carotid artery disease and HRQoL. The cross-sectional study included 33 patients who were referred for carotid artery endarterectomy. Data assessment was done one to three days before surgery. The HRQoL was assessed using the Medical Outcome Survey Form 36 (SF-36v2). Patients with symptomatic carotid artery disease had the lowest mean SF-36v2 scores for physical functioning, role-physical, general health and mental health. There was moderate correlation (rs = 0.441) between mean SF- 36v2 scores of mental health and Montreal Cognitive Assessment Scale (MoCA) scores. There is also indirect indication for probable correlation between MoCA test scores and mean SF-36v2 scores of social functioning, which might become statistically significant if more patients would be included. Patients with severe carotid artery disease in our study had lower mean SF-36v2 scores for role-physical, for bodily pain and for perception about their health status (general health). HRQoL in patients with severe carotid artery, stenosis was poorer in patients with symptomatic carotid artery disease and was not affected by gender and other clinical characteristics.

PO-0035 Propranolol Administration For Treatment Of Immature Infantile Haemangiomas(iih) In Infants; Any Cardiac Effects?

<h3>Introduction</h3> Propranolol is now being used as an alternative to steroid treatment for IIH. Aim of the study To evaluate the cardiac effects of propranolol in infancy. <h3>Methods</h3> All patients with IIH between January 2011–December 2013, treated with propranolol, underwent cardiac examination: heart rate (HR), blood pressure (BP), satO2, electrocardiogram and echocardiography (shortening fraction and ejection fraction). Cardiac evaluation was repeated after 1 week, 4 weeks, and then every 6 months. <h3>Results</h3> We have analysed 42 patients divided into 2 groups: 33 patients (1–6 months, mean weight 6.5 ± 1.3 kg) and 9 patients (6–15 months, mean weight 10.6 ± 2.4 kg). No adverse effects in any patients and none required discontinuation of treatment. In the first group the median HR centile was 50th at baseline, 41thafter 1month and 44th at the end of treatment. In the second group the median HR centile was 43th at baseline, 34th after 1 month and 37th at the end of treatment. In the first group the mean SF was 39% at baseline, 40% and 40% at the end of treatment: the mean EF was respectively 74.5%, 72% and 73%. For the second group the mean SF was 38%, 39% and 39%: the mean EF respectively was 73.1% at baseline, 74% after 1 month and 74.2% at the end of treatment. <h3>Conclusion</h3> In our study we have observed signs of rapid involution of hemangioma within the 2–3 first weeks of treatment in all patients. All patients have responded well to treatment, with no side effects and especially no cardiac effect.

Inflammation profile in overweight/obese adolescents in Europe: an analysis in relation to iron status.

The objectives of this study were to investigate the relationship between inflammatory parameters (CRP, c-reactive protein; AGP, α1-acid glycoprotein), iron status indicators (SF, serum ferritin; sTfR, soluble transferrin receptor) and body mass index (BMI) z-score, fat-free mass (FFM) and fat mass (FM) in European adolescents. Differences in intake for some nutrients (total iron, haem and non-haem iron, vitamin C, calcium, proteins) were assessed according to BMI categories, and the association of nutrient intakes with BMI z-score, FM and FFM was evaluated. A total of 876 adolescents participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence-Cross Sectional Study were included in the study sample. Mean CRP values (standard error; s.e.) were significantly higher in overweight/obese adolescents (1.7±0.3 and 1.4±0.3 mg/l in boys and girls, respectively) than in thin/normal-weight adolescents (1.1±0.2 and 1.0±0.1 mg/l in boys and girls, respectively) (P<0.05). For boys, mean SF values (s.e.) were significantly higher in overweight/obese adolescents (46.9±2.7 μg/l) than in thin/normal-weight adolescents (35.7±1.7 μg/l) (P<0.001), whereas median sTfR values did not differ among BMI categories for both boys and girls. Multilevel regression analyses showed that BMI z-score and FM were significantly related to CRP and AGP (P<0.05). Dietary variables did not differ significantly among BMI categories, except for the intake of vegetable proteins, which, for boys, was higher in thin/normal-weight adolescents than in overweight/obese adolescents (P<0.05). The adiposity of the European adolescents was sufficient to cause chronic inflammation but not sufficient to impair iron status and cause iron deficiency.

AB0876 Fonctional Disability and Quality of Life in Patients with Neck Pain

BackgroundNeck pain is a common condition in rheumatology. Few data emphasize their impact on functional disability and quality of life among Moroccan patientsObjectivesTo evaluate functional disability, quality of life, and...

The MESS: is it must?

Background: Massive lower extremity trauma presents an immediate and complex decision making challenge. Significant advancements have made in the field of reconstructive surgery over the past 30 years. Severely traumatised limbs which would have been treated by primary amputation 20 years ago are beginning to be saved. On the contrary, such extensive reconstructive procedures may not always produce the best of results in terms of functional outcomes. Thus the management of a severely crushed extremity presents a therapeutic dilemma as whether to amputate or to attempt salvage. Methods: All Prospective study of 40 patients with severe crush injury to the lower extremities treated in Sri Ramachandra Medical College, Chennai between June 2012 and June 2014. The inclusion criteria were grade IIIb and grade IIIc open fractures of the lower extremity with a Mangled extremity severity score (MESS) of 7 and above with minimum of 12 months follow up. All the fractures were classified according to the Gustilo and Anderson classification system and Mangled extremity severity score. Out of the 40 patients 18 of them had their limbs salvaged and 22 underwent primary amputation. Results: The lowest MESS in this study was 7 and highest MESS was 12. The mean score in the limb salvage group was 8 and in the amputated group was 9.7. Complication rates in salvage group were higher. The mean SF score for amputated group for physical component summary was 40.15 and mental component summary was 44.30 while for limb salvage group score for physical component summary was 30.91 and mental component summary was 36.90. Conclusions: The MESS scheme provides excellent guidelines to the treating surgeon when faced with a dilemma of whether to attempt salvage or amputate a severely injured limb. The decision of whether to amputate or salvage an injured limb must be made very early in the course of treatment. This is because immediate amputation is most often viewed by the patient as a result of injury; whereas, delayed amputation is often considered as a failure of treatment.