University College London Hospitals NHS Foundation Trust
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Purpose The aim of this systematic review was to analyse the effect of quadriceps anatomical factors on patellar stability. Methods The protocol for this review was registered on PROSPERO with registration number CRD42022334265. A systematic PRISMA compliant database search was conducted. Electronic databases (MEDLINE, Global Health, MIDIRS, Embase, PsycARTICLES and APA PsycInfo), currently registered studies, conference proceedings and the reference lists of included studies were searched. A narrative synthesis provided a summary of current evidence pertaining to the effect of quadriceps anatomical factors on patellar stability. Results A total of 9168 records were screened in the initial search. Of these, 20 articles satisfied the inclusion criteria, assessing 754 knees of 689 patients, and 69 cadaveric knees. Vastus medialis obliquus strength (VMO) affected patellar stability up to 15° of knee flexion, whereas medial retinaculum integrity did so up to 30° of knee flexion. Studies disagreed as to whether this applied to the rest of knee flexion. There is conflicting evidence regarding the effect of VMO elevation, cross-sectional area and angulation on patellar stability. The lateral retinaculum contributed to patellar stability throughout the entirety of knee flexion. Quadriceps angle altered patellar orientation during knee flexion, but not extension. Conclusion Whilst vastus medialis obliquus strength was found to be a determinant of patellar stability, there is conflicting evidence regarding the effect of VMO morphological parameters on patellar stability. The lateral retinaculum provided stability throughout the entirety of knee flexion, and the medial retinaculum did so up to 30° of flexion.
Background The risk of toxicity-related dose delays, with cancer treatment, should be included as part of pretreatment education and be considered by clinicians upon prescribing chemotherapy. An objective measure of individual risk could influence clinical decisions, such as escalation of standard supportive care and stratification of some patients, to receive proactive toxicity monitoring. Patients and methods We developed a logistic regression prediction model (Delay-7) to assess the overall risk of a chemotherapy dose delay of 7 days for patients receiving first-line treatments for breast, colorectal and diffuse large B-cell lymphoma. Delay-7 included hospital treated, age at the start of chemotherapy, gender, ethnicity, body mass index, cancer diagnosis, chemotherapy regimen, colony stimulating factor use, first cycle dose modifications and baseline blood values. Baseline blood values included neutrophils, platelets, haemoglobin, creatinine and bilirubin. Shrinkage was used to adjust for overoptimism of predictor effects. For internal validation (of the full models in the development data) we computed the ability of the models to discriminate between those with and without poor outcomes (c-statistic), and the agreement between predicted and observed risk (calibration slope). Net benefit was used to understand the risk thresholds where the model would perform better than the ‘treat all’ or ‘treat none’ strategies. Results A total of 4604 patients were included in our study of whom 628 (13.6%) incurred a 7-day delay to the second cycle of chemotherapy. Delay-7 showed good discrimination and calibration, with c-statistic of 0.68 (95% confidence interval 0.66-0.7), following internal validation and calibration-in-the-large of −0.006. Conclusions Delay-7 predicts a patient’s individualised risk of a treatment-related delay at cycle two of treatment. The score can be used to stratify interventions to reduce the occurrence of treatment-related toxicity.
Background: Catatonia is a psychomotor syndrome that has a wide range of aetiologies. Determining whether catatonia is due to a medical or psychiatric cause is important for directing treatment but is clinically challenging. We aimed to ascertain the performance of the electroencephalogram (EEG) in determining whether catatonia has a medical or psychiatric cause, conventionally defined. Methods: In this systematic review and meta-analysis of diagnostic test accuracy (PROSPERO CRD42021239027), Medline, EMBASE, PsycInfo, and AMED were searched from inception to May 11, 2022 for articles published in peer-reviewed journals that reported EEG findings in catatonia of a medical or psychiatric origin and were reported in English, French, or Italian. Eligible study types were clinical trials, cohort studies, case–control studies, cross-sectional studies, case series, and case reports. The reference standard was the final clinical diagnosis. Data extraction was conducted using individual patient-level data, where available, by two authors. We prespecified two types of studies to overcome the limitations anticipated in the data: larger studies (n ≥ 5), which were suitable for formal meta-analytic methods but generally lacked detailed information about participants, and smaller studies (n
Recent advances in lymphatic imaging have provided novel insights into the lymphatic system. Interventional radiology has played a significant role in the development of lymphatic imaging techniques and modalities. Radiologists should be familiar with the basic physiology and anatomy of the lymphatic system to understand the imaging features of lymphatic disorders, which reflect their pathophysiology. This study comprehensively reviews the physiological and anatomical aspects of the human lymphatic system as well as the latest lymphatic imaging techniques.
Lymphatic disorders encompass a broad spectrum of diseases involving the lymphatic system, ranging from traumatic lymphatic leaks to lymphatic malformations. Lymphatic disorders can be categorized into traumatic and non-traumatic disorders according to their etiology. These two categories may be further divided into subgroups depending on the anatomical location of the lymphatic pathology and their association with clinical syndromes. Thoracic duct embolization was a milestone in the field of lymphatic intervention that encouraged the application of percutaneous embolization techniques to treat leaks and reflux disorders in the lymphatic system. Additional access routes for embolization, including retrograde thoracic duct and transhepatic lymphatic access, have also been developed. This article comprehensively reviews a variety of options for the treatment of lymphatic disorders, from conservative management to the most recent embolization techniques.
Background: Lung cancer screening with low-dose CT reduces lung cancer mortality, but screening requires equitable uptake from candidates at high risk of lung cancer across ethnic and socioeconomic groups that are under-represented in clinical studies. We aimed to assess the uptake of invitations to a lung health check offering low-dose CT lung cancer screening in an ethnically and socioeconomically diverse cohort at high risk of lung cancer. Methods: In this multicentre, prospective, longitudinal cohort study (SUMMIT), individuals aged 55-77 years with a history of smoking in the past 20 years were identified via National Health Service England primary care records at practices in northeast and north-central London, UK, using electronic searches. Eligible individuals were invited by letter to a lung health check offering lung cancer screening at one of four hospital sites, with non-responders re-invited after 4 months. Individuals were excluded if they had dementia or metastatic cancer, were receiving palliative care or were housebound, or declined research participation. The proportion of individuals invited who responded to the lung health check invitation by telephone was used to measure uptake. We used univariable and multivariable logistic regression analyses to estimate associations between uptake of a lung health check invitation and re-invitation of non-responders, adjusted for sex, age, ethnicity, smoking, and deprivation score. This study was registered prospectively with, NCT03934866. Findings: Between March 20 and Dec 12, 2019, the records of 2 333 488 individuals from 251 primary care practices across northeast and north-central London were screened for eligibility; 1 974 919 (84·6%) individuals were outside the eligible age range, 7578 (2·1%) had pre-existing medical conditions, and 11 962 (3·3%) had opted out of particpation in research and thus were not invited. 95 297 individuals were eligible for invitation, of whom 29 545 (31·0%) responded. Due to the COVID-19 pandemic, re-invitation letters were sent to only a subsample of 4594 non-responders, of whom 642 (14·0%) responded. Overall, uptake was lower among men than among women (odds ratio [OR] 0·91 [95% CI 0·88-0·94]; p<0·0001), and higher among older age groups (1·48 [1·42-1·54] among those aged 65-69 years vs those aged 55-59 years; p<0·0001), groups with less deprivation (1·89 [1·76-2·04] for the most vs the least deprived areas; p<0·0001), individuals of Asian ethnicity (1·14 [1·09-1·20] vs White ethnicity; p<0·0001), and individuals who were former smokers (1·89 [1·83-1·95] vs current smokers; p<0·0001). When ethnicity was subdivided into 16 groups, uptake was lower among individuals of other White ethnicity than among those with White British ethnicity (0·86 [0·83-0·90]), whereas uptake was higher among Chinese, Indian, and other Asian ethnicities than among those with White British ethnicity (1·33 [1·13-1·56] for Chinese ethnicity; 1·29 [1·19-1·40] for Indian ethnicity; and 1·19 [1·08-1·31] for other Asian ethnicity). Interpretation: Inviting eligible adults for lung health checks in areas of socioeconomic and ethnic diversity should achieve favourable participation in lung cancer screening overall, but inequalities by smoking, deprivation, and ethnicity persist. Reminder and re-invitation strategies should be used to increase uptake and the equity of response. Funding: GRAIL.
A multi-site randomized controlled trial was carried out between 2015 and 2019 to evaluate the impacts on quality of life of an intradialytic exercise programme for people living with chronic kidney disease. This included a qualitative process evaluation which gave valuable insights in relation to feasibility of the trial and of the intervention in the long-term. These can inform future clinical Trial design and evaluation studies. A constructivist phenomenological approach underpinned face-to-face, semi-structured interviews. Purposive recruitment ensured inclusion of participants in different arms of the PEDAL Trial, providers with different roles and trial team members from seven Renal Units in five study regions. Following ethical review, those willing took part in one interview in the Renal Unit. Audio-recorded interviews were transcribed (intelligent verbatim) and inductively thematically analyzed. Participants (n = 65) (Intervention arm: 26% completed; 13% who did not; Usual care arm: 13%; 46% women; 54% men; mean age 60 year) and providers (n = 39) were interviewed (23% PEDAL Trial team members). Three themes emerged: (1) Implementing the Intervention; (2) Implementing the trial; and (3) Engagement of the clinical team. Explanatory theory named “the Ideal Scenario” was developed, illustrating complex interactions between different aspects of intervention and trial implementation with the clinical context. This describes characteristics likely to optimize trial feasibility and intervention sustainability in the long-term. Key aspects of this relate to careful integration of the trial within the clinical context to optimize promotion of the trial in the short-term and engagement and ownership in the long-term. Strong leadership in both the clinical and trial teams is crucial to ensure a proactive and empowering culture. Novel explanatory theory is proposed with relevance for Implementation Science. The “Ideal Scenario” is provided to guide trialists in pre-emptive and ongoing risk analysis relating to trial feasibility and long-term intervention implementation. Alternative study designs should be explored to minimize the research-to-practice gap and optimize the likelihood of informative findings and long-term implementation. These might include Realist Randomized Controlled Trials and Hybrid Effectiveness-Implementation studies.
Background Low-level exposure to carbon monoxide (CO) is a significant health concern but is difficult to diagnose. This main study aim was to establish the prevalence of low-level CO poisoning in Emergency Department (ED) patients. Methods A prospective cross-sectional study of patients with symptoms of CO exposure was conducted in four UK EDs between December 2018 and March 2020. Data on symptoms, a CO screening tool and carboxyhaemoglobin were collected. An investigation of participants’ homes was undertaken to identify sources of CO exposure. Results Based on an ED assessment of 4175 participants, the prevalence of suspected CO exposure was 0.62% (95% CI; 0.41–0.91%). CO testing in homes confirmed 1 case of CO presence and 21 probable cases. Normal levels of carboxyhaemoglobin were found in 19 cases of probable exposure and in the confirmed case. Conclusion This study provides evidence that ED patients with symptoms suggestive of CO poisoning but no history of CO exposure are at risk from CO poisoning. The findings suggest components of the CO screening tool may be an indicator of CO exposure over and above elevated COHb. Clinicians should have a high index of suspicion for CO exposure so that this important diagnosis is not missed Screening patients for unintentional carbon monoxide exposure in the Emergency Department: a cross-sectional multi-centre study | Journal of Public Health | Oxford Academic (
Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This protocol is for two separate reviews to assess the effects (benefits and harms) of immunosuppressant and immunomodulatory treatments for the idiopathic inflammatory myopathies. Targeted treatments To assess the effects (benefits and harms) of targeted immunosuppressant and immunomodulatory treatments for the idiopathic inflammatory myopathies: dermatomyositis (DM, including juvenile dermatomyositis, jDM), immune mediated necrotising myopathy (IMNM), anti‐synthetase syndrome (ASS), overlap‐myositis (OM) and polymyositis (PM). We will also include cancer‐related myositis and amyopathic dermatomyositis. Non‐targeted treatments To assess the effects (benefits and harms) of non‐targeted immunosuppressant and immunomodulatory treatments for the idiopathic inflammatory myopathies: dermatomyositis (DM, including juvenile dermatomyositis, jDM), immune mediated necrotising myopathy (IMNM), anti‐synthetase syndrome (ASS), overlap‐myositis (OM) and polymyositis (PM). We will also include cancer‐related myositis and amyopathic dermatomyositis.
There is significant use of alternative diets by people living with cancer, with data suggesting this has continued to increase since the 1980s. Commonly used alternative diets include the ketogenic diet, Gerson therapy, alkaline diets and fasting diets. This article explains the latest trends in relation to alternative diets, discusses the reasons why people may want to use these and examines their hypothesised mechanisms of action. The author outlines and critically reviews the evidence underpinning the use of such diets in those living with cancer, and suggests that this remains weak. The article also explores the challenges that nurses may experience when a person living with cancer wishes to adopt an alternative diet, and provides practical advice and recommendations on nutrition.
Introduction: Due to medical improvements leading to increased life expectancy after renal transplantation and widened eligibility criteria allowing older patients to be transplanted, incidence of (low-risk) prostate cancer (PCa) is increasing among renal transplant recipients (RTR). It remains to be established whether active surveillance (AS) for PCa represents a safe treatment option in this setting. Therefore, we aim to compare AS discontinuation and oncological outcomes of AS for PCa of RTR vs. non-transplant patients. Methods: Multicentre study including RTR diagnosed with PCa between 2008 and 2018 in whom AS was initiated. A subgroup of non-RTR from the St. Antonius hospital AS cohort was used as a control group. Comparison of RTR vs. non-RTR was performed by 2:1 propensity score matched survival analysis. Outcome measures included tumour progression-free survival, treatment-free survival, metastasis rates, biochemical recurrence rates and overall survival. Patients were matched based on age, year of diagnosis, PSA, biopsy ISUP grade group, relative number of positive biopsy cores and clinical stage. Results: A total of 628 patients under AS were evaluated, including 17 RTRs and 611 non-RTRs. A total of 13 RTR cases were matched with 24 non-RTR cases. Median overall follow-up for the RTR and non-RTR matched cases was, respectively, 5.1 (IQR 3.2-8.7) years and 5.7 (IQR 4.8-8.1) years. There were no events of metastasis and biochemical recurrence among matched cases. The matched-pair analysis results in a 1-year and 5-year survival of the RTR and non-RTR patients were, respectively, 100 vs. 92%, and 39 vs. 76% for tumour progression, 100 vs. 91% and 59 vs. 76% for treatment-free survival and, respectively, 100 vs. 100% and 88 vs. 100% for overall survival. No significant differences in tumour progression-free survival (p = 0.07) and treatment-free survival were observed (p = 0.3). However, there was a significant difference in overall survival comparing both groups (p = 0.046). Conclusions: AS may be carefully considered in RTR with low-risk PCa. In our preliminary analysis, no major differences were present in AS outcomes between RTR and non-RTR. Overall mortality was significantly higher in the RTR subgroup.
Background Despite improved postoperative management, endoscopic recurrence after surgery remains common in Crohn’s disease (CD) patients [1]. It is widely accepted that patients receiving preoperative nutrition supplementation are less likely to experience postoperative complications [2]. However, little is known about the long-term effects of preoperative nutrition supplementation on surgery. In this study we aimed to assess the long-term effects of preoperative nutrition supplementation on endoscopic recurrence. Methods Single centre retrospective data was collected between 2015 and 2021 on patients who had surgical resection with ileocolonic anastomosis. Follow up data was retrospectively collected at 12 months after surgery. Endoscopic recurrence was defined as a Rutgeerts score of 2 or more. Statistical analysis included demographics and inferential analyses. Missing data was attributed to the absence in clinic notes. Results This study included 50 CD patients [50.0% male, median age of 31.0 (18.0-68.0), 81.8% non-smokers] who had ileocolonic anastomosis. Most patients had ileocolonic CD (76.0%, 38/50) and either stricturing (46.0%, 23/50) or penetrating (26.0%, 13/50) disease behaviour. Almost half (49.0%, 24/49) of CD patients received preoperative nutrition supplementation prior to surgery, with 61.9% on oral nutrition supplementation. No statistical difference was found between the demographics of patients receiving nutrition supplementation and patients without nutrition supplementation, p>0.05 (table 1). Endoscopic recurrence was observed in 43.5% (10/23) of patients at 12 months. 80.0% (8/10) of patients who experienced endoscopic recurrence did not receive preoperative nutrition supplementation (figure 1). Logistic regression indicated that patients receiving nutrition supplementation may be 84.4% less likely to experience endoscopic recurrence at 12 months compared to patients without nutrition supplementation (OR 0.16 (CI 0.023-1.056)(p=0.057)). The type of preoperative nutrition supplementation did not significantly impact endoscopic recurrence (p>0.05). Conclusion Preoperative nutrition supplementation may reduce the risk of endoscopic recurrence one year after surgical resection. The use of preoperative nutrition is highly recommended for all CD patients undergoing surgery. More extensive research is needed to confirm study findings.
Introduction There is an urgent need to develop an international competency and capability framework to support standardization of education and roles in advanced practice physiotherapy (APP). This need arose due to the rapid growth of the APP model of care, implemented out of necessity in the absence of agreement as to the competencies and capabilities or formal education required for the roles. This study explores the views and perceptions of practitioners and key stakeholders on a draft competency and capability framework for advanced practice physiotherapists. Objectives The purpose of this study was to: 1) gather feedback from key stakeholders (advanced practice physiotherapists, researchers, and leaders) on a draft competency and capability framework and 2) use that feedback to revise and improve the draft framework. Design Qualitative study using a series of four multi-national online focus groups. Thematic analysis was conducted according to Braun and Clarke. Results Sixteen participants from the United Kingdom, Ireland, Canada, Australia, and New Zealand participated in the study. Five themes were generated after data analysis: clinical expert, experienced communicator, strong leader, collaborator, and knowledge creator). A modified competency and capability framework was developed based on feedback from the focus groups and input from subject matter experts (SMEs). Conclusion This study provides a modified core competency and capability framework comprising 24 competencies grouped under six domains. This study is a step toward international standardization of advanced practice physiotherapy based on a commonly agreed framework for the education and training of advanced practice physiotherapists.
Background More than one fifth of Crohn’s disease patients will require surgery within 5 years of diagnosis, rising to over 90% throughout their lifetime. Sarcopenia is defined as a disease process of skeletal muscle decline in mass, function, and physical performance. Emerging evidence suggests sarcopenia may be implicated with Crohn’s disease severity and poorer outcomes. Several sarcopenia assessment tools exist with varying accuracy, however CT or MR images at the level of the third lumbar vertebra (L3) can reliably predict whole-body composition. Our aim was to assess the prevalence of sarcopenia via L3 scores in pre-operative Crohn’s disease patients and examine its impact on post-operative outcomes. Methods This single-centre, retrospective study collected data from 95 Crohn’s disease patients undergoing surgery between 2015-2021 and followed up for 12 months. Pre-operative baseline characteristics and post-operative outcomes were recorded immediately after surgery and at 30 days, 1, 6 and 12 months. Infectious and non-infectious complications were recorded, including but not limited to: abscess, collection, wound site infection, anastomotic leak, venous thromboembolism, haemorrhage. Sarcopenia was assessed from CT and MR imaging at the level of L3 within 3 months of surgery, and was defined as per the Martin et al. equation. Results Of 58 Crohn’s disease patients with pre-operative imaging, sarcopenia was prevalent at 74.1% (43/58). Pre-operative Harvey-Bradshaw Index was significantly higher in those with sarcopenia (sarcopenic group: 8, non-sarcopenic: 4, p<0.001). In addition, anaemia adjusted for gender was more prevalent in the sarcopenic group versus non-sarcopenic (56.1% [23/41] versus 25% [3/15], p=0.058). Sarcopenic patients experienced higher rates of infective complications within 30 days of surgery (22.5% [9/40] versus 0, p=0.052). Conclusion The prevalence of sarcopenia is higher in Crohn’s disease patients undergoing surgery than first thought and may be implicated in disease severity. Our study found that sarcopenia is associated with increased rates of infective post-operative complications. Further studies are required to corroborate our findings and identify appropriate interventions for sarcopenia. In conclusion, sarcopenia in Crohn’s disease may reflect a phenotype of aggressive disease implicated with worse post-operative outcomes.
Background Strict eligibility criteria of phase 3 trials limit the external validity of their results. Well-designed real-world studies are intended to complement these by describing the effectiveness and safety of these medicines in routine clinical practice. As therapeutic options for the treatment of Crohn’s disease (CD) expands, the ideal sequence of medications, and the influences on this, needs defining. Methods UndieS is a phase IV, multi-centre, prospective, observational study of patients with CD initiated on ustekinumab as part of their routine care. 600 participants will be recruited from 22 centres across the UK with a follow-up period of 2 years. Assessments at baseline and weeks 8, 16/20, 56, 80 and 104 include modified Harvey-Bradshaw Index (mHBI), IBD-Control, Treatment Satisfaction Questionnaire for Medication and PRO-2. The primary outcome is steroid-free remission (mHBI ≤ 4) at one year. Secondary outcome measures include describing changes in disease activity, PROs and tolerability. Results Recruitment started in March 2020 with 437 patients recruited so far. The summary baseline characteristics are 50% male, median (range) age at consent 41 (18-91) years (14% > 65 years), median mHBI 5 (0-39). The median duration of Crohn’s disease before starting ustekinumab was 8 (0-60) years. Disease location (as per Montreal classification) is: L1: 35%, L2: 20%, L3: 44% and isolated L4: 1%. 24% of participants reported perianal disease. The proportion of participants using concomitant immunomodulators or oral corticosteroids on starting ustekinumab (15% and 11% respectively) is lower than in the UNITI clinical trial program. 59% of participants had a disease activity score suggesting that they would not meet the threshold required for entry into UNITI and suggested by NICE for moderately-to-severely active CD, although 81% of these had evidence of inflammation. Inadequate response to or adverse effects from a previous treatment was a common indication (52% of participants). 32% of the participants are bio-naïve; 64% and 10% have previous exposure to anti-TNF and vedolizumab respectively and 6% have been exposed to both. Details of prior biologic exposure is shown in figure 1. The most common reasons for the specific choice of ustekinumab were intolerance to immunomodulators and concern about infection risk. Bio-naïve patients were older (median 45 vs. 39 years; p=0.02) and had a shorter disease duration (7 vs. 9 years; p=0.04) than those with prior biologic exposure. Conclusion Our cohort is representative of those patients with CD being treated with ustekinumab in a real-world setting. Some important differences between these patients and those recruited to phase 3 clinical trials are identified.
Background Sarcopenia, a reduction in muscle mass and function, is a poorly recognised phenomenon in Crohn’s disease (CD) despite occurring in 16%-68% of CD patients [1-5]. It has been linked to both an increased need for surgery and increased risk of postoperative complications. However, the role of sarcopenia in CD and its long-term impact on surgical outcomes are unknown. We aimed to assess the link between sarcopenia and postoperative clinical recurrence. Methods Retrospective data was collected between 2015 and 2021 from CD patients who had undergone gastrointestinal surgery and a MR or CT scan within 3 months prior to surgery. Follow up data was retrospectively collected for 6 months. MR and CT scans were used to determine skeletal muscle area (SMA) from the cross-sectional L3 vertebrae, which was used to identify patients as sarcopenic or not. Clinical recurrence was defined as a Harvey-Bradshaw Index of 5 or more. Statistical analysis included demographics and inferential analyses. Missing data was attributed to the absence in clinic notes. Results This single centre study included 64 CD patients [56.3% male, median age of 30.0 (18.0-76.0), 87.7% non-smokers] who had undergone gastrointestinal surgery. Most patients had ileocolonic CD (74.6%, 47/63) and either stricturing (46.9%, 30/64) or penetrating (31.3%, 20/64) disease behaviour, and 23.4% (15/64) had perianal disease. 45.3% (29/64) of patients had had at least one previous surgery. Preoperatively, 20.6% (13/63) of patients were on steroids and 55.6% (35/63) were on combined drug therapy. Patient median SMA was 113.6 (61.8 – 281.7) cm2 with sarcopenia found in 74.1% (43/58) of patients. SMA was lower in females (females: 92.1±19.3 cm2 vs males: 137±39.5 cm2, p<0.001) and patients with a BMI<18.5 kg/m2 (BMI<18.5 kg/m2: 91.8±19.1 cm2 vs BMI≥18.5 kg /m2: 120.3±33.3 cm2, p=0.004) (figure 1). Postoperative clinical recurrence was observed in 17.8% (8/45) of patients at 6 months. Patients with clinical recurrence had a significantly lower SMA (87.4 ± 18.5 cm2) compared to those without clinical recurrence (120.9 ± 39.2 cm2) (p=0.001) (figure 2). Patients with a lower SMA were 1.1 times more likely to have clinical recurrence at 6 months compared to patients with a higher SMA (OR 1.05 (CI 1.01-1.10)(p=0.022)). Conclusion Sarcopenia is highly prevalent in preoperative CD patients. Patients with early clinical recurrence had a significantly lower SMA. SMA may be useful in predicting CD patients at risk of early postoperative clinical recurrence. However, more research is needed to confirm study findings.
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1,427 members
Himanshu Tyagi
  • Tourette Service, Neuropsychiatry, Neurorehabilitation
Ellen Merete Hagen
  • Autonomic Unit (National Hospital for Neurology and Neurosurgery)
Gary Woodward
  • Department of Clinical Biochemistry
Gwen Gonzales
  • Uro-Neurology
London, United Kingdom