Significant Change In Percentage Research Articles

The impact of metformin on weight and metabolic parameters in patients with obesity: A systematic review and meta-analysis of randomized controlled trials.

There are conflicting data on the weight-reducing potential of metformin (MTF) in nondiabetic patients with obesity. The purpose of this systematic review and meta-analysis was to evaluate the effect of MTF on weight and cardiometabolic parameters in adults with overweight/obesity with or without nonalcoholic fatty liver disease (NAFLD) (CRD42018085512). We included randomized controlled trials (RCTs) in adults without diabetes mellitus, with mean body mass index (BMI) ≥ 25 kg/m2, with or without NAFLD, comparing MTF to placebo/control, lifestyle modification (LSM) or a US Food and Drug Administration-approved anti-obesity drug, reporting on weight or metabolic parameters, and extending over at least 3 months. We conducted a systematic search in MEDLINE, EMBASE, PubMed and the Cochrane Library without time limitation (until March 2022). We screened and selected eligible articles, abstracted relevant data, and assessed the risk of bias. All steps were in duplicate and independently. We conducted a random-effects model meta-analysis using Review Manager version 5.3, with prespecified subgroup analyses in case of heterogeneity. We identified 2650 citations and included 49 trials (55 publications). Compared to placebo, MTF was associated with a significant reduction in BMI (mean difference [MD] -0.56 [-0.74, -0.37] kg/m2; p < 0.0001), at doses ranging from 500 to 2550 mg/day, and with a significant percentage change in BMI of -2.53% (-2.90, -2.17) at the dose 1700 mg/day. There was no interaction by baseline BMI, MTF dose or duration, nor presence or absence of NAFLD. There was no significant difference between MTF and LSM. Orlistat was more effective than MTF (at doses of 1000-1700 mg/day) in terms of weight loss, with an MD in BMI of -3.17 (-5.88; -0.47) kg/m2, favouring the former. Compared to placebo/control, MTF improved insulin parameters, while no effect was detected when compared to LSM. A few small trials showed heterogenous effects on liver parameters in patients with NAFLD treated with MTF compared to placebo/control. There was a large variability in the expression of outcome measures and RCTs were of low quality. In conclusion, MTF was associated with a modest weight reduction in obese nondiabetic patients. Further high-quality and better powered studies are needed to examine the impact of MTF in patients with insulin resistance and NAFLD.

Reduced self-harm on acute mental health wards following the implementation of a vision-based patient monitoring system: Evidence from five NHS trusts.

WHAT IS KNOWN ON THE SUBJECT?: Inpatient mental health settings pose unique challenges for patient safety, in part because psychiatric disorders are well-known risk factors for self-harm and suicide. Ward staff follow protocols to try and keep patients safe including carrying out in-person safety checks, usually every 15 min, but patients unfortunately still find opportunities to harm themselves. A vision-based patient monitoring system (VBPMS) is a contact-free technology that can help mental health nurses to monitor patients in hospital more effectively. For example, the tool alerts staff to situations where a patient might need assistance, like when they spend a long period of time in their ensuite bathroom. Research has shown that the VBPMS can support staff to prevent safety incidents from occurring and a recent study found a decrease in self-harm after the tool was implemented at one NHS mental health trust. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This paper presents data from five NHS mental health trusts and suggests that the VBPMS can consistently help staff to prevent self-harm on acute mental health wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Managing self-harm behaviours is a challenge for mental health nursing staff. Standard safety protocols are not effective enough - staff need new ways to monitor patients. In general hospitals, technology is used every day to support care. This research shows that the VBPMS can be used to improve patient safety in mental health hospitals. ABSTRACT: Introduction Self-harm is sadly relatively common in mental health inpatient settings, and the effectiveness and appropriateness of strategies used to prevent it have long been disputed. The use of vision-based patient monitoring systems (VBPMS) has been shown to improve various safety outcomes. Their potential to support staff in preventing inpatient self-harm warrants further exploration. Aim This research investigated whether implementing a VBPMS-as an adjunct to existing clinical practice-within acute inpatient services at five NHS England mental health trusts led to reductions in self-harm. Method Five quasi-experimental studies assessed the number of bedroom self-harm incidents, across 12 adult wards, before and 5-12 months after a VBPMS was deployed. Percentage changes were calculated. Four studies used control groups and were included in a fixed-effect meta-analysis. Results In the meta-analysis, a significant inverse-weighted average relative risk percentage change of -38.9% was recorded. For the study with no control groups, reductions in self-harm were seen across all wards (range: -9.1% to -29.8%). Discussion This research demonstrates that VBPMS can support clinicians to create safer ward environments by preventing incidents of self-harm from occurring. Implications for Practice The results provide preliminary support for wider rollout of the technology on acute mental health wards.

Changes in confocal microscopy in glaucoma patients after intraocular pressure reduction with medical therapy.

Topical glaucoma medication is the first line of management to reduce intraocular pressure (IOP) in patients with glaucoma. In this study, we intended to compare the ultrastructural findings of the cornea in patients with glaucoma before and after the reduction of the IOP through confocal microscopy. Ten patients (19 eyes) with newly diagnosed glaucoma were recruited from the glaucoma services of our tertiary care center. Demographic parameters were noted, and basic ocular examination, specular microscopy (Topcon SP3000P, Tokyo, Japan), and ultrasonic pachymetry (300 AP, Sonomed Escalon, Stoneham, MA, USA) were performed. In vivo confocal microscopy of corneal sections was performed using the z-ring Confoscan 4.0 (Nidek, Inc., Freemont, CA) at baseline and after 3 months of starting glaucoma medications. The mean age of the patients was 53.53 ± 9.34 years. There was a statistically significant reduction (P < 0.0001) of IOP from 30.21 ± 7.42 mmHg (baseline) to 16.42 ± 4.14 mmHg (3 months). The mean central corneal thickness at baseline was 533.42 ± 3.96 μm, and it further decreased to 521.94 ± 42.45 μm at the end of 3 months (P = 0.006). No significant change was noted in the mean epithelial cell density, mean keratocyte density in anterior and posterior stroma, and the mean endothelial cell density and cell area (P >0.5). There was no significant percentage change in these parameters before and after the lowering of the IOP. A short-term (3 months) decrease in IOP using topical glaucoma medications caused a significant reduction in corneal thickness but did not have any significant ultrastructural changes in cornea measured using confocal microscopy.

(212) Minimally Invasive Surgical Therapies for Benign Prostatic Hyperplasia in the Geriatric Population: A Systematic Review

Abstract Introduction Benign prostatic hyperplasia (BPH) is an extremely common disease in aging men and can lead to lower urinary tract symptoms (LUTS) and complications. While the initial management of BPH includes behavioral modifications and pharmacologic therapies, older patients have increased susceptibility to adverse events (AEs) and therefore have decreased compliance. Consequently, geriatric patients may benefit from minimally invasive surgical therapies (MISTs) as treatment alternatives for BPH. Currently, there is no systematic review describing MISTs outcomes in specifically older populations. Objective To evaluate the efficacy and safety profile of MISTs in geriatric patients with BPH. Methods PubMed/MEDLINE database was systematically searched for relevant articles in the English language through June 24, 2023. Studies that evaluated surgical and/or urinary outcomes of MISTs in geriatric patients (≥65 years of age) were deemed eligible. Studies were included if there was separate reporting for age subgroups ≥65 years, if mean age minus SD was ≥65 years, or if median age minus Q1 was ≥65 years. Studies with patients with catheter dependent urinary retention were not excluded. Results A total of 263 studies were screened, of which 22 (N=2,911 patients) met inclusion. Of the 22 studies, 3 evaluated PAE, 1 evaluated Rezum, 7 evaluated GreenLight, 4 evaluated HoLEP, 4 evaluated ThuLEP, 1 evaluated DiLEP, 1 evaluated Aquablation, and 1 evaluated both PAE + Rezum. The Rezum study and the PAE + Rezum study only included patients with an indwelling catheter at baseline. Follow-up ranged between 1 and 36 months (median 12 months). All the MISTs were performed inpatient and required hospitalization. Hospitalization times ranged between 0.9 and 7.6 days (median 3 days) and was the longest for DiLEP (median 7.6 days) and PAE (median 5.1 days) and the shortest for Rezum (median 1 day). Procedure time ranged between 4.8 and 148 minutes (median 70.6 minutes), with PAE having the longest time (median 102 minutes) and Rezum having the shortest time (median 6.4 minutes). When compared to baseline, PAE, GreenLight, HoLEP, ThuLEP, DiLEP, and Aquablation showed significant percent changes in international prostate symptom score (median -69.6%), quality of life (-72.7%), maximum urinary flow (113.1%), and postvoid residual (-80.1%) at a median of 12 months postoperatively. The studies assessing catheter independence in patients with chronic urinary retention reported a catheter-free rate of 100% for Rezum and 45.5% for PAE at 12 months postoperatively. Occurrence of AEs ranged between 0 and 67.5% (median 12.2%). AEs were lowest for HoLEP (median 4.6%) and Rezum (median 8.8%) and highest for PAE (33.1%) and Aquablation (34%). Reoperation rates across all MISTs ranged between 0 and 5% (median 1.5%) at a median of 12 months postoperatively. Conclusions Although all the MISTs reviewed in this study resulted in durable improvements in LUTS secondary to BPH in the geriatric population, differences in procedural characteristics and safety profiles across MISTs were considerable. Rezum had the shortest procedure and hospitalization time and lowest occurrence of AEs, while PAE had the longest procedure and hospitalization time and highest occurrence of AEs. Additional studies evaluating Rezum in elderly patients without urinary retention are warranted. Disclosure No.

(210) Four-Year Surgical and Sexual Function Outcomes of Rezum Therapy Across a Broad Range of Prostate Volumes

Abstract Introduction Benign prostatic hyperplasia (BPH) often leads to the development of lower urinary tract symptoms (LUTS), which can result in significant deterioration in quality of life (QoL). Rezum therapy has demonstrated efficacy in alleviating LUTS secondary to BPH across a broad range of prostate volumes (PVs). However, there is a scarcity of long-term real-world data on Rezum outcomes across a wide range of PVs. Objective To evaluate surgical and sexual function Rezum outcomes over a 4-year period in patients with PVs &amp;lt;30cc, 30-80cc, or &amp;gt;80cc. Methods A retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were stratified into three cohorts based on PV: &amp;lt;30cc, 30-80cc, or &amp;gt;80cc. Outcome measures, including International Prostate Symptom Score (IPSS), QoL, International Index of Erectile Function (IIEF)-Erectile and Orgasmic function, maximum urinary flow rate (Qmax), BPH medication usage, adverse events (AEs), and decisional regret scores were collected and compared at baseline and 1-, 3-, 6-, 12-, and/or 48-months follow-up. Results A total of 252 patients were analyzed, with 35 (13.9%), 196 (77.8%), and 21 (8.3%) patients in the 30cc, 30-80cc, and &amp;gt;80cc cohorts, respectively. The &amp;gt;80cc cohort was significantly older (66.9 years [8.1]) than the &amp;lt;30cc cohort (63.4 years [8.5], p = 0.02). The &amp;lt;30cc cohort had a significantly higher baseline IPSS (21 [15-28]) and QoL (5 [4-6]) than the 30-80cc (IPSS 17 [10-23], p = 0.003; QoL 4 [3-5], p=0.02) and &amp;gt;80cc (IPSS 16 [6.5-22.5], p = 0.01; QoL 4 [3-5], p = 0.006) cohorts. The number of injections utilized per lateral prostatic lobe significantly increased with PV (&amp;lt;30cc: 1 injection [0-1] vs 30-80cc: 2 injections [1-2] vs &amp;gt;80cc: 3 injections [2-3.5], p &amp;lt; 0.001). When compared to baseline, the combined cohort saw significant percent changes at 48-months in IPSS (-70.6%, p &amp;lt; .001), QoL (-80%, p &amp;lt; .001), and Qmax (52%, p = 0.003). Within each PV cohort, significant improvements in IPSS and QoL were found at all follow-ups when compared to baseline. Qmax improvements were significant only in the 30-80cc cohort at all follow-ups. There were no significant differences in percent changes in IPSS, QoL, or Qmax between cohorts at 3-, 6-, 12-, or 48-months when compared to baseline. The &amp;lt;30cc and 30-80cc cohorts had significant decreases in BPH medication usage as early as 3-months that remained durable through 48-months (all p &amp;lt; 0.05). The &amp;gt;80cc cohort experienced a significant decrease in BPH medication usage at 3-months but it did not remain durable to 12- or 48-months. No significant differences in postoperative AEs or decision regret scores were observed between cohorts. There were no significant changes in erectile function and orgasmic function at 12-months within cohorts. No significant differences were found in 48-months reoperation rates between the &amp;lt;30cc, 30-80cc, and &amp;gt;80cc cohorts (0% vs 4.9% vs 5%, p = 0.49). Conclusions Rezum effectively improved LUTS secondary to BPH irrespective of PV, with improvements being durable over 4 years. However, patients with PVs &amp;gt;80cc should be counseled on the possibility of continuing their BPH medications following treatment. Disclosure No.

Electro-acupuncture for central obesity: a patient-assessor blinded, randomized sham-controlled clinical trial

BackgroundCentral obesity is considered as a significant health threat to individuals. Scientific research has demonstrated that intra-abdominal fat accumulation is associated with higher metabolic and cardiovascular disease risks independent of Body Mass Index (BMI). This study aimed to evaluate the efficacy and safety of electro-acupuncture in treating central obesity compared with sham acupuncture.MethodThis was a patient-assessor blinded, randomized, sham-controlled clinical trial. One hundred sixty eight participants aged between 18 and 65 years old with BMI ≥ 25 kg/m2 and waist circumference (WC) of men ≥ 90 cm / women ≥ 80 cm were enrolled and allocated to the acupuncture or sham acupuncture group equally. For the acupuncture group, disposable acupuncture needles were inserted into eight body acupoints, including Tianshu (ST-25), Daheng (SP-15), Daimai (GB-26), Qihai (CV-6), Zhongwan (CV-12), Zusanli (ST-36), Fenglong (ST-40), and Sanyinjiao (SP-6) with electrical stimulation. For the control group, Streitberger’s non-invasive acupuncture needles were utilized at the same acupoints with identical stimulation modalities. The treatment duration was 8 weeks with 2 sessions per week and the follow-up period was 8 weeks. The primary outcome was the change in WC before and after the treatment. The secondary outcomes were the changes in hip circumference, waist-to-hip circumference ratio, BMI, and body fat percentage during the treatment and follow-up period.ResultsThe acupuncture group displayed a significant change in WC compared to the sham group both treatment and follow-up period (MD = -1.1 cm, 95% CI = -2.8 to 4.1). Significant change in body fat percentage was recorded for both groups after treatment but no significance was observed during the follow-up period (MD = -0.1%, 95% CI = -1.9 to 2.2). The changes in hip circumference were also significant both treatment and follow-up period for the acupuncture group (MD = -2.0 cm, 95% CI = -3.7 to -1.7). Compared with sham acupuncture, the body weight (MD = -1 kg, 95% CI = -3.3 to 5.3), BMI (MD = -0.5, 95% CI = -0.7 to 1.9) also decreased significantly within and between groups. The incidence of adverse events was similar in the two groups.ConclusionThis study provided evidence that electro-acupuncture could be effective in treating central obesity by reducing WC, hip circumference, body weight, BMI, and waist-to-hip circumference ratio.Trial registrationClinicalTrials.gov Identifier: NCT03815253, Registered 24 Jan 2019.

Therapeutic Effects of BRC Functional Food from Indonesian Black Rice on Body Weight and Haematological Parameters in Obese Rats

Obesity increases the risk of various diseases. Black rice, renowned for its high anthocyanin content, is considered a potential functional food for preventing metabolic disorders. The current study investigated the effects of black rice crunch (BRC) on body weight and haematological profiles in obese rats. Rats were fed with high-fat diet to induce obesity and supplemented with different concentrations of BRC for 4 and 8 weeks. The results showed that high-fat diet effectively induced obesity, as evidenced by significant increase in body weight. Importantly, 75% BRC supplementation resulted in significant weight reduction in obese rats. Further analysis revealed an increase in erythrocyte numbers in obese groups supplemented with 75% BRC, but no significant changes in haemoglobin concentration or haematocrit percentage. Further investigation showed that 75% BRC led to a decrease in mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), and mean corpuscular volume (MCV), potentially affecting the size and concentration of haemoglobin within erythrocytes. The total leucocytes count increased with the high-fat diet, while BRC supplementation alone did not have significant impact. Lymphocyte percentage remained stable across the groups, indicating minimal influence of the dietary interventions. Neutrophil percentage varied initially but was not specific to BRC or the high-fat diet. Platelet count and distribution width were not significantly influenced, but mean platelet volume (MPV) increased after 8 weeks of BRC treatment, suggesting larger platelet sizes associated with obesity. Overall, the study provides important insights into the effects of BRC supplementation on body weight and haematological parameters related to obesity. 

Hybrid Renewable Energy Microgrids: A Genetic Algorithm Approach to System Design

The paper examines the use of genetic algorithm (GA) methods to optimize hybrid renewable energy microgrids by merging various renewable sources and energy storage technologies. An examination of meteorological data over many days reveals fluctuations in solar irradiance ranging from 4.8 kW/m² to 5.5 kW/m² and wind speed oscillating between 3.9 m/s and 4.5 m/s, indicating the presence of dynamic weather conditions. An analysis of energy generating capabilities reveals a wide range of potentials, with solar capacities varying from 80 kW to 150 kW and wind capacities ranging from 60 kW to 120 kW across different sources. An analysis of Energy Storage System (ESS) specifications shows a range of values for maximum capacities, charge/discharge efficiencies (ranging from 85% to 96%), and maximum charge/discharge rates (from 60 kW to 100 kW), highlighting the need for flexible energy storage systems. The examination of microgrid load profiles reveals the presence of diverse energy needs, with residential loads oscillating between 48 kW and 55 kW, commercial loads ranging from 40 kW to 47 kW, and industrial loads spanning from 30 kW to 36 kW. A percentage change study reveals the ability to adapt, with solar irradiance and wind speed showing mild fluctuations of roughly 14% and nearly 15% respectively. In contrast, renewable source capacity demonstrate significant percentage changes ranging from around 40% to 50%. These results highlight the ever-changing characteristics of renewable energy sources, underlining the need for strong optimization tactics in microgrid systems. The study emphasizes the potential of GA-based approaches in developing efficient microgrids, promoting sustainable and dependable energy solutions in the face of changing environmental circumstances and varied energy requirements.

Lung ultrasound and high-resolution computed tomography quantitative variations during nintedanib treatment for systemic sclerosis-associated interstitial lung disease.

Lung ultrasound (LUS) and high-resolution computed tomography (HRCT) are commonly used for the evaluation of interstitial lung disease (ILD). Nintedanib (NIN) is an antifibrotic therapy approved for systemic sclerosis-associated ILD (SSc-ILD). We assessed LUS and quantitative HRCT changes in SSc-ILD patients treated with NIN during a one-year follow-up, evaluating relationships between imaging variations and functional or quality-of-life outcomes. SSc-ILD patients who started NIN were enrolled and followed for twelve months. Pulmonary function tests and patient-reported outcome measures (PROMs) were assessed half-yearly and quarterly, respectively. LUS was performed quarterly evaluating the presence of B-lines (BL) and pleural line irregularities (PLI). HRCT was repeated after one year and quantitatively analysed with CALIPER software. Ten patients (70% female, mean age 62 years) were enrolled. The mean total number of both BL and PLI was constantly decreased during NIN treatment, being significantly reduced after twelve months (from 175.1 ± 66.7-120.8 ± 70.3 for BL, p= 0.005 and from 50.6 ± 32.5-37.2 ± 22.4 for PLI, p= 0.05). Male gender, smoking habit and baseline forced vital capacity <70% predicted were associated with worse LUS outcomes. A greater reduction of both BL and PLI was observed in those who improved in PROMs, especially modified Medical Research Council dyspnoea scale (p= 0.016 and p= 0.04, respectively) and Saint George's Respiratory Questionnaire (p= 0.006 and p= 0.026, respectively). No significant changes in the CALIPER percentages of normal parenchyma or ILD elements were observed after twelve months of NIN, thus paralleling the stabilization obtained at pulmonary function tests. We present preliminary results on NIN effects on SSc-ILD as assessed by LUS, a useful method for frequently repeated monitoring, and CALIPER, a valid implementation whenever a HRCT is performed.

Bailout inclisiran-based triple lipid-lowering therapy reduces plaque lipid content in stable coronary artery disease patients

Abstract Background Low-density lipoprotein cholesterol (LDL-C) has a causal role in atherosclerotic cardiovascular disease. Genetic studies and variability in individual response to lipid-lowering therapies suggest combining hypolipidaemic medications with different mechanisms of action. Purpose The aim of this study was to evaluate the effect of triple inclisiran-based hypolipidaemic therapy in patients not reaching LDL-C target on maximum statin/ezetimibe treatment. Methods This prospective study enrolled 37 stable coronary artery disease patients admitted for elective percutaneous coronary intervention after 4-6 weeks on maximum tolerated statin and/or ezetimibe therapy during run-in period. Afterwards, patients with LDL-C level &amp;gt;1.8 mmol/l at the time of inclusion were assigned to receive add-on inclisiran (triple therapy group). In all participants near-infrared spectroscopy (NIRS) was performed at baseline and after 15 months for atherosclerotic plaque evaluation in the segment of interest, defined as 20-50% lesion in the proximal or middle third of a coronary artery. Statistical analysis was carried out with SPSS Statistics software. Results Average LDL-C level among screened patients was 2.81 (±1.17) mmol/l. In 19 patients LDL-C level remained &amp;gt;1.8 mmol/l on maximally tolerated statin and/or ezetimibe treatment, and after 15 months of triple therapy mean LDL-C reached 1.81 (±1.02) mmol/l with a significant LDL-C percentage change of 35.59% (95%CI -47.31 to -9.18, P=0.006) in this group. 17 patients continued statin/ezetimibe as mono or dual treatment and at 15-month follow-up mean LDL-C level comprised 1.67 (±0.61) mmol/l among these participants. According to NIRS data, maximum lipid-core burden index within 4 mm (maxLCBI4 mm) was significantly reduced by 28.85 (95%CI -189.39 to 17.64, P=0.041) in triple therapy group and by 114.72 in mono or dual therapy group (-194.76 to 23.01, P=0.004), with no statistically significant difference established between both groups (P=0.494). Conclusions Triple therapy demonstrated significant atherosclerotic plaque lipid content reduction along with LDL-C level lowering in patients with insufficient effectiveness of statin/ezetimibe treatment.

The effects of water-based circuit exercise training on vascular function in people with coronary heart disease.

Impaired endothelial function in people with coronary heart disease (CHD) is associated with increased mortality. Water immersion can increase peripheral artery shear stress which may provide an additional stimulus to the endothelium during exercise. This study compared the effects of water-based circuit exercise training (WEX) and gym-based circuit exercise training (GEX) on vascular function in people with stable CHD. Participants were randomised to 12 weeks of WEX (n=20), GEX (n=20) or a control group (usual activities; n=12). Endothelium-dependent flow-mediated dilation (FMD) and glyceryl trinitrate-mediated dilation (GTN) of the brachial artery were assessed pre- and post-intervention. FMD increased following WEX [4.0% (3.0-5.1%) to 5.3% (4.1-6.5%); p=0.016], but was unchanged following GEX [4.9% (3.8-5.9%) to 5.0% (3.8-6.1%); p=0.822]. There were no between-group differences in the change in FMD and no significant changes in GTN-mediated dilation percentage. Triglycerides decreased following GEX [1.2 mmol.L-1 (1.0-1.4 mmol.L-1) to 1.0 mmol.L-1 (0.8-1.3 mmol.L-1); p=0.022], but there were no further differences in lipid profiles. WEX improved endothelial function of the brachial artery in people with stable CHD, suggesting that WEX is an effective alternative to gym-based exercise in people living with CHD, which may specifically address vascular health.

Taking a chance on outcome standardisation: A cross-sectional analysis assessing the uptake of the prevention of preterm birth core outcome set in randomised controlled trials.

Analyse uptake of the core outcome set (COS) within preterm birth (PTB) clinical trials. On 26 June 2023, we conducted a systematic search of phase III/IV trial registry entries regarding PTB interventions via ClinicalTrials.gov and the International Clinical Trial Registry Platform. These trials were analysed for the outcomes measured. N/A. After searching the two databases, 5257 randomised controlled trials (RCTs) were screened, resulting in 92 RCTs for analysis. Inclusion criteria were the following: subjects were patients receiving an intervention for PTB, study enrolment began within 5 years prior to publication of PTB COS to 26 June 2023, and evaluated the efficacy of interventions. Authors screened and extracted data in masked, duplicate fashion, then performed an interrupted time series analysis, analysis of variance and correlation analysis. We extracted outcomes measured by each clinical trial in our sample. Trials were analysed for the percentage of adopted outcomes from PTB COS. After COS publication, there was no significant change in percentage of COS outcomes measured. The most measured outcome was 'offspring mortality' (54.34%, 50/92) and the least measured outcome was 'late neonatal neurodevelopment morbidity' (3.26%, 3/92). Additionally, 22.83% (21/92) of trials measured zero outcomes related to the PTB COS. Our results demonstrated no significant change in outcome measurement before or after PTB COS publication. We recommend focusing on both the measurement of outcomes and the assessments that are used.

FRI096 Efficacy Of Pemafibrate In Patients With Dyslipidemia: A Systematic Review And Meta - Analysis Of Randomized Controlled Trials

Abstract Disclosure: C.A. Balieiro: None. N.R. Nakajima: None. M.M. Gobbo: None. B.A. Gonçalves: None. N.D. Peixoto: None. E.T. Sirena: None. M.B. Moreira: None. In individuals with dyslipidemia, which is a well-known risk factor for cardiovascular events, pemafibrate may improve lipid abnormalities. We aimed to perform a systematic review and meta-analysis of randomized clinical trials (RCT) comparing pemafibrate to either placebo or fenofibrate in patients with hypertriglyceridemia. The PubMed, Cochrane, and Embase databases were searched for RCTs only. Data were extracted from published reports, and quality assessment was performed according to PRISMA guidelines. We used a random-effects model to calculate the mean difference (MD) and the 95% confidence interval (CI). The primary endpoints of interest were percent changes in triglycerides (TG) and non-HDL cholesterol. The review protocol is registered at PROSPERO, under the number CRD42022374852. Nine studies involving 12,644 patients were included. Of all participants, 6,699 (53%) received the intervention. There was a higher percentage of decrease in serum TG in the pemafibrate group at the dose of 0.4 mg/day (MD −48.29 [−61.45, −35.13], 95% CI; P &amp;lt; 0.0001, I2 = 93%), in comparison to placebo. In addition, non-HDL levels were significantly lower in patients treated with pemafibrate at the dose of 0.4 mg/day when compared to placebo (MD - 6.35, [−10.62, −2.08], 95% CI; P &amp;lt; 0.0001, I2 = 82%). There was no significant percent change in TG between patients treated with pemafibrate 0.2 mg/day compared when compared to fenofibrate 200 mg/day (MD −2.90 [−12.90, 7.11], 95% CI; P = 0.003, I2 = 83%), neither in the pemafibrate groups at the doses of 0.1 mg/day (MD 43.72 [-53.51, -33.93], 95% CI; P = 0.06, I2 = 60%) and 0.2 mg/day (MD −47.30 [−53.99, −40.60] , 95% CI; P = 0.11, I2 = 47%) when compared to placebo. Decrease of non-HDL levels were not significantly different when comparing pemafibrate and placebo, neither at the dose of 0.1 mg/day (MD -7.11 [−10.71, - 3.50], 95% CI; P = 0.26, I2 = 25%) nor 0.2 mg/day (MD - 7.70 [-10.66, −4.74], 95% CI; P = 0.20, I2 = 33%). Our meta-analysis demonstrates that pemafibrate is effective in lowering triglycerides and non-HDL levels in patients with dyslipidemia compared to placebo. Furthermore, the difference in reduction between pemafibrate and fenofibrate was not statistically significant. This study represents the most current evidence. Keywords: Dyslipidemia, Pemafibrate, Triglycerides Presentation: Friday, June 16, 2023

Secular trend of mortality and incidence of rheumatoid arthritis in global ,1990–2019: an age period cohort analysis and joinpoint analysis

BackgroundRheumatoid arthritis (RA) is a major public health problem. Unfortunately, there is a scarcity of comprehensive and up-to-date information regarding the burden of RA and its dynamic trends in subsequent years. To examine the changing trends in the global burden of RA and forecast for 2044, which will facilitate the development of strategies tailored to RA burden and provide reference for the development of effective treatment guidelines.MethodsFollowing the general analytical strategy used the Global Burden of Disease Study (GBD) 2019, which included 204 countries, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) and age-standardized disability adjusted of life year (DALY) rate for RA were analyzed.ResultsThe ASIR, ASMR and age-standardized DALY rate for RA in 2019 were 13.001/100,000 (95% UI, 11.833 ~ 14.274), 0.574/100,000 (95% UI, 0.356 ~ 0.793) and 39.565/100,000 (95% UI, 49.529 ~ 30.508), respectively. America had the highest ASIR [18.578(95% UI, 17.147 ~ 20.148)] and age-standardized DALY rate [53.676(95% UI, 40.106 ~ 67.968)] in 2019. Asia had the highest ASMR [0.681(95% UI, 0.802 ~ 0.480)] in 2019. From 1990 to 2019, a significant average annual percentage change (AAPC) in the ASIR was observed in both males [0.237% (95% CI, 0.216 ~ 0.259%)] and females [0.197% (95% CI, 0.141 ~ 0.254%)], AAPC in the ASMR was observed in both males [-0.398% (95% CI, -0.605~-0.191%)] and females [-0.295% (95% CI, -0.424~-0.65%)]. Age effects indicated that the relative risk (RR) of RA-associated incidence and mortality rates increased with age among males and females. The RR of RA increased over time and started to gradually increase from 1990. Cohort effects showed decreases in incidence, mortality and DALY rates in successive birth cohorts. The global incidence of RA would continue to increase in the future, while mortality would continue to decrease.ConclusionThe increased risk of RA is dominantly influenced by age effects and period effects and the ethnic area. The results suggest that early identification and treatment of RA is important for reducing the ongoing burden with age, and targeted health education and specific intervention programs should be promoted to control middle-elderly population.

Association of per- and polyfluoroalkyl substances with hepatic steatosis and metabolic dysfunction-associated fatty liver disease among patients with acute coronary syndrome

Etiology of hepatic steatosis and metabolic dysfunction-associated fatty liver disease (MAFLD) among acute coronary syndrome (ACS) remains unclear. Existing studies suggested the potential role of per- and polyfluoroalkyl substances (PFAS) in comorbidity of hepatic steatosis among ACS patients. Therefore, we conducted a cross-sectional study based on the ACS inpatients to assess the associations of plasma PFAS congeners and mixtures with hepatic steatosis and MAFLD. This study included 546 newly diagnosed ACS patients. Twelve PFAS were quantified using ultra-high-performance liquid chromatography-tandem mass spectrometry. Hepatic steatosis was defined by hepatic steatosis index (HSI). MAFLD was defined as the combination of hepatic steatosis based on the risk factor calculation with metabolic abnormalities. Generalized linear model was used to examine the associations of PFAS congeners with HSI and MAFLD. Adaptive elastic net (AENET) was further used for PFAS congeners selection. Mixture effects were also assessed with Bayesian kernel machine regression model (BKMR). Congeners analysis observed significant greater percent change of HSI for each doubling in PFOS (1.82%, 95% CI: 0.87%, 2.77%), PFHxS (1.17%, 95% CI: 0.46%, 1.89%) and total PFAS (1.84%, 95% CI: 0.56%, 3.14%). Moreover, each doubling in PFOS (OR=1.42, 95% CI: 1.13, 1.81), PFHxS (OR=1.31, 95% CI: 1.09, 1.59) and total PFAS (OR=1.43, 95% CI: 1.06, 1.94) was associated with increased risk of MAFLD. In AENET regression, only PFOS presented significant positive associations with HSI. Mixture analysis indicated significant positive associations between PFAS mixtures and HSI. This is the first study to demonstrate associations of PFAS congeners and mixtures with hepatic steatosis and MAFLD among ACS patients, which provides hypothesis into the mechanisms behind comorbidity of hepatic steatosis among ACS patients, as well as tertiary prevention of ACS.

Assessment of adulteration in honey by artificial sweeteners using dynamic laser speckle technique

Our research work uses the dynamic laser speckle technique for the first time to analyze the adulteration of “Dabur Honey” with two golden syrups Dhampur Green Golden Syrup (DGGS) and Solar Golden Syrup (SGS) as adulterate. Identifying 25% adulteration in honey by sweeteners is challenging due to several reasons, such as the complexity of honey composition and the similarity of some sweeteners to honey. A spatially filtered He-Ne laser beam is made to pass through adulterated samples. Forwarding scattered light is captured using a charge-coupled device (CCD) camera and Digital Image Processing is used to analyze the images. Seven textures and six features of images are evaluated. For 20% adulteration in honey by both the adulterates, a significant percentage change of 17%, 16%, 16%, 13%, and 11% is observed in Angular Second Moment, Covariance, Autocorrelation, Inertia, and Kurtosis respectively. Additionally, for a 20% adulteration in honey by DGGS and SGS separately, a notable percentage change of 3.8% and 6.6% respectively in the value of Inertia Moment (IM) is obtained. Thus, it is concluded that the above image processing algorithms can be used to detect 20% adulteration in pure honey.

Nutritional state of orthognathic surgery patients: A systematic review and meta-analysis

PurposeIs to systematically review the available evidence of the patient's nutritional state before and after orthognathic surgery MethodsThe protocol to the International Prospective Register of Systematic Reviews (PROSPERO; registration No. CRD42020177156). ResultsThe search strategy yielded a total of 43 articles from all databases. Of the 43 articles, 13 were excluded after an examination of the titles and abstracts, and full-text articles of the remaining 30 studies were reviewed independently for eligibility. Of these 30 studies, 23 were excluded because they did not meet the inclusion criteria. Finally, a total of 7 studies met the inclusion criteria and were processed for critical review ConclusionPatient's body weight and body mass index (BMI) decreases after orthognathic surgery. No significant changes in body fat percentage were observed. The estimated blood loss and the need for blood transfusion increased. No significant changes were observed in hemoglobin levels, lymphocyte counts, total cholesterol levels, and cholinesterase levels between the pre-operative and postoperative periods. Increments in serum albumin levels and total protein counts were observed after orthognathic surgery.

Perencanaan Kebijakan Persediaan Vaksin Booster Dengan Metode Continuous Review (s,S) Untuk Mengurangi Overstock Di Rumah Sakit Tentara Kota Pematangsiantar

Pematangsiantar City Army Hospital is one of the state-owned health facilities that provides booster vaccination services with 4 types of booster vaccines available, namely sinovac, astrazeneca, pfizer and moderna. The uncertain level of demand for booster vaccines causes the Pematangsiantar City Army Hospital to require booster vaccine inventory policy planning using the continuous review (s,S) method to prevent overstock which results in considerable cost expenditures. From the calculation of booster vaccine inventory control using the continuous review method (s,S), it is obtained that the total inventory cost has a significant percentage change. For the type of sinovac, the percentage change in total inventory costs reaches 92% of the total inventory costs in the existing conditions, for astrazeneca reaches 58% of the total inventory costs in the existing conditions, for pfizer reaches 60% of the total inventory costs in the existing conditions, and for moderna reaches 95% of the total inventory costs in the existing conditions. The results of the calculation of the total cost of inventory with continuous review (s,S) can provide a decrease in costs incurred by the Pematangsiantar City Army Hospital. This is because the continuous review (s,S) inventory policy minimises the cost of vaccine shortages which are quite costly.

Poster 253: Is the Use of Pretreatment Magnetic Resonance Imaging Necessary Prior to Surgery in Pediatric Tibial Spine Fractures

Objectives: Injuries to the tibial spine occur as a result of an anterior cruciate ligament (ACL) avulsion fracture from the intercondylar eminence of the proximal tibia. Similar to anterior cruciate ligament ruptures, tibial spine injuries are associated with damage to other intraarticular structures. These associated injuries are often visualized with Magnetic Resonance Imaging (MRI) obtained prior to surgery. The purpose of the study is to describe concomitant injuries visualized by a pretreatment MRI, to examine how this correlates to what is seen at the time of surgery, and to determine how a pretreatment MRI affects the time between injury and surgery as well the length of the surgical procedure itself. Our hypothesis is that a pretreatment MRI results in a longer time between injury and surgery without any affect on operating time or amount of concomitant pathology identified. Methods: Utilizing an institutional review board approved retrospective study, we identified patients under 18 years of age who underwent arthroscopic management of a tibial spine fracture over a 13 year period. Our exclusion criteria were patients with a concomitant ipsilateral lower extremity fracture or posterior cruciate ligament injury, patients with poor imaging quality, and patients with incomplete medical records. Patients were then categorized based on whether they obtained a pretreatment MRI. We then evaluated for concomitant injuries, time from injury to surgery, total room time, and tourniquet time between the groups. Results: A total of 85 patients met this inclusion criteria, of which 44 (51.7%) had a pretreatment MRI. There were no significant differences in age, gender, or Myers and McKeever grade between groups. All were treated with arthroscopic reduction and fixation. In the MRI group, there were 30 patients (68.2%) that were identified to have additional meniscal or chondral pathology. The three most common pathologies seen on MRI were lateral meniscus tears (13 patients), medial meniscus tears (6 patients), and intermeniscal ligament entrapment (6 patients). In addition, 28 patients (63.6%) were found to have a bone contusion pattern similar to that seen in ACL injuries and 17 patients (38.6%) showed signs of damage to the ACL fibers themselves. Of those 30 patients with meniscal pathology or entrapment seen on MRI, 17 patients (56.7%) were confirmed to have that pathology at the time of arthroscopy. The percentage of patients with meniscal or chondral pathology seen on arthroscopy was not significantly different between those who received a pretreatment MRI and those who did not (38.6% MRI group vs 41.5% No-MRI group p =0.79). The time from injury to surgery was significantly longer in the MRI group (19.3 days vs 10.1 days p=0.01). Both the tourniquet time (72 min vs 76 min) and operative time (83.5 min vs 90.5 min) were not significantly different(p=0.49 for tourniquet time and p=0.32 for room time). Conclusions: Over two-thirds of patients who sustained a tibial spine fracture were noted to have concomitant pathology on MRI, with 56.7% of injuries seen on MRI correlating to what was seen at the time of surgery. The use of pretreatment MRI was shown to delay surgery without any significant change in operative time, tourniquet time, or percentage of pathology identified at time of surgery. Previous studies have suggested that a pre-treatment MRI may be helpful in identifying pathology, however we believe this is the first study to determine if obtaining a pretreatment MRI influences operative time, tourniquet time, and pathology identified at time of surgery.

Estimating the effect of certain manufacturing parameters for fiber laminated composites: A validated DQM model integrated with RSM

The purpose of this research is to develop a mathematical model between the specified certain parameters related to laminated composite design and the corresponding critical buckling load (CBL) of the structure. Therefore, Response Surface Method (RSM) based on the central composite design (CCD) is utilized as the experimental design approach. The CBLs are determined using the validated differential quadrature model (DQM) based on the classical plate theory for 30 different combinations determined by CCD. For the uniaxial loading case, statistical indicators of the simplified model are determined as 0.96, 0.95 and 0.91 for R2, Adj- R2 and Pred-R2, respectively. ANOVA results of the reduced quadratic regression model show that the most significant parameter is length-to-width ratio with a contribution of 32.23%, whereas the least is the fiber orientation angle of the central layer with a contribution ratio of 1.06%. Another significant outcome of the research is that an increment in the fiber angle from 0° to 90° has a very dominant effect (49.83%) on buckling load for a constant value of the length-to-width ratio of 0.5. Comparing the response surface results for biaxial loading to uniaxial loading reveals a similar overall trend, but a significant percentage change in the fiber angle for outer layers is observed when the length-to-width ratio is constant, as evident from the analysis of the obtained results.