Scleroderma and related disorders: 223. Long Term Outcome in a Contemporary Systemic Sclerosis Cohort

Background: We have previously compared outcome in two groups of systemic sclerosis (SSc) patients with disease onset a decade apart and we reported data on 5 year survival and cumulative incidence of organ disease in a contemporary SSc cohort. The present study examines longer term outcome in an additional cohort of SSc followed for 10 years. Methods: We have examined patients with disease onset between years 1995 and 1999 allowing for at least 10 years of follow-up in a group that has characteristics representative for the patients we see in contemporary clinical practice. Results: Of the 398 patients included in the study, 252 (63.3%) had limited cutaneous (lc) SSc and 146 (36.7%) had diffuse cutaneous (dc) SSc. The proportion of male patients was higher among the dcSSc group (17.1% v 9.9%, p = 0.037) while the mean age of onset was significantly higher among lcSSc patients (50 ± 13 v 46 ± 13 years ± SD, p = 0.003). During a 10 year follow-up from disease onset, 45% of the dcSSc and 21% of the lcSSc subjects developed clinically significant pulmonary fibrosis, p < 0.001. Among them approximately half reached the endpoint within the first 3 years (23% of dcSSc and 10% of lcSSc) and over three quarters within the first 5 years (34% and 16% respectively). There was a similar incidence of pulmonary hypertension (PH) in the two subsets with a steady rate of increase over time. At 10 years 13% of dcSSc and 15% of lcSSc subjects had developed PH (p=0.558), with the earliest cases observed within the first 2 years of disease. Comparison between subjects who developed PH in the first and second 5 years from disease onset demonstrated no difference in demographic or clinical characteristics, but 5-year survival from PH onset was better among those who developed this complication later in their disease (49% v 24%), with a strong trend towards statistical significance (p = 0.058). Incidence of SSc renal crisis (SRC) was significantly higher among the dcSSc patients (12% v 4% in lcSSc, p = 0.002). As previously observed, the rate of development of SRC was highest in the first 3 years of disease- 10% in dcSSc and 3% in lcSSc. All incidences of clinically important cardiac disease developed in the first 5 years from disease onset (7% in dcSSc v 1% in lcSSc, p < 0.001) and remained unchanged at 10 years. As expected, 10-year survival among lcSSc subjects was significantly higher (81%) compared to that of dcSSc patients (70%, p = 0.006). Interestingly, although over the first 5 years the death rate was much higher in the dcSSc cohort (16% v 6% in lcSSc), over the following years it became very similar for both subsets (14% and 13% between years 5 and 10, and 18% and 17% between years 10 and 15 for dcSSc and lcSSc respectively). Conclusions: Even though dcSSc patients have higher incidence for most organ complications compared to lcSSc subjects, the worse survival among them is mainly due to higher early mortality rate. Mortality rate after first 5 years of disease becomes comparable in the two disease subsets. Disclosure statement: The authors have declared no conflicts of interes

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

The benefits of strength training on musculoskeletal system health: practical applications for interdisciplinary care

Global health organizations have provided recommendations regarding exercise for the general population. Strength training has been included in several position statements due to its multi-systemic benefits. In this narrative review, we examine the available literature, first explaining how specific mechanical loading is converted into positive cellular responses. Secondly, benefits related to specific musculoskeletal tissues are discussed, with practical applications and training programmes clearly outlined for both common musculoskeletal disorders and primary prevention strategies

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Postural control in Tunisian soccer players

La relation entre la contribution de la vision et le niveau d’expertise sur le contrôle postural semble dépendre du sport pratiqué. Le but de notre travail est d’analyser le contrôle postural et l’utilisation de l’information visuelle chez les footballeurs en fonction de leur niveau de compétition. Méthodes : Deux groupes de footballeurs ont été étudiés : groupe amateurs (AM) niveau régional (n = 16) et un groupe de professionnels au niveau national (PRO) (n = 16). Le paramètre postural a été évalué en mesurant la vitesse d’oscillation du centre de gravité (CG) avec une force plate-forme « Balance Master® » lors d’un essai (30 s) en appui bipodal et unipodal yeux ouverts, et puis, yeux fermés. Résultats : La vitesse d’oscillation de CG est significativement plus élevée dans le groupe AM que dans le groupe PRO en condition yeux ouverts et yeux fermés. La vision et le facteur surface engendrent des différences statistiquement significatives chez les deux groupes (p < 0,05). La fermeture des yeux en condition appui bipodal sur sol souple a entraîné une augmentation des vitesses d’oscillation du CG du groupe AM par rapport à celle du le groupe PRO (p < 0,05). Conclusion : Le rôle de la vison chez les footballeurs de niveau professionnel est moins important dans le maintien de l’équilibre que celui des footballeurs amateurs. Mots clés : Contrôle postural; Footballeur; Vision; Exper

Postural control in Tunisian soccer players

La relation entre la contribution de la vision et le niveau d’expertise sur le contrôle postural semble dépendre du sport pratiqué. Le but de notre travail est d’analyser le contrôle postural et l’utilisation de l’information visuelle chez les footballeurs en fonction de leur niveau de compétition. Méthodes : Deux groupes de footballeurs ont été étudiés : groupe amateurs (AM) niveau régional (n = 16) et un groupe de professionnels au niveau national (PRO) (n = 16). Le paramètre postural a été évalué en mesurant la vitesse d’oscillation du centre de gravité (CG) avec une force plate-forme « Balance Master® » lors d’un essai (30 s) en appui bipodal et unipodal yeux ouverts, et puis, yeux fermés. Résultats : La vitesse d’oscillation de CG est significativement plus élevée dans le groupe AM que dans le groupe PRO en condition yeux ouverts et yeux fermés. La vision et le facteur surface engendrent des différences statistiquement significatives chez les deux groupes (p < 0,05). La fermeture des yeux en condition appui bipodal sur sol souple a entraîné une augmentation des vitesses d’oscillation du CG du groupe AM par rapport à celle du le groupe PRO (p < 0,05). Conclusion : Le rôle de la vison chez les footballeurs de niveau professionnel est moins important dans le maintien de l’équilibre que celui des footballeurs amateurs. Mots clés : Contrôle postural; Footballeur; Vision; Exper

The effects of a soccer season on anthropometric characteristics, physical fitness, and soccer skills in North African elite female youth soccer players

Backround and objectives In comparison to their European counterparts, there are scarce data regarding skill performance in young elite female North African soccer players. The objectives of this study were to evaluate the effects of a season-long training regime on anthropometric and physical performance characteristics, agility, and soccer skills in Tunisian youth elite female players. Materials and methods Forty-eight females (24 soccer players SG; 24 non-playing controls, CG) were evaluated at the start of a preparatory period (T1) in September, and 10 months later in June (T2), the end period of the competitive season. Anthropometrics (body mass, body composition), soccer-specific cardiorespiratory endurance (Yo-Yo Intermittent Recovery Test Level 1; YYIRT1), muscle power (countermovement jump [CMJ]; squat-jump [SJ]; 5-Jump-Test [5JT]), agility (T-test with and without ball), soccer skill (Loughborough Soccer Passing Test, LSPT) and sprint speed (30 m sprint with 5 and 10 m splits) were measured. Results The SG experienced significant performance improvements in all tests across the period of the competitive season, demonstrating better improvements in height (P < 0.0001, ES = 1.69), weight (P < 0.0001, ES = 0.92) and BF (P < 0.0001, ES = 1.63). Better CMJ (P < 0.0001, ES = 1.63), SJ (P < 0.0001, ES = 1.33), and 5JT performances than the CG (P < 0.004, ES = 0.39). Similarly, the SG performed better in the sprint, agility, and LSPT tests and covered longer distances in YYIRTL1 (P < 0.0001) compared to the CG. Conclusion Soccer season training contributed to significant variations in anthropometric characteristics, physical fitness, and soccer skills in Tunisian elite female youth soccer players compared to control group that are beyond those which could be expected through biological maturation alone

Progressive circuit resistance training improves inflammatory biomarkers and insulin resistance in obese men

Circuit resistance training (CRT) is a time-efficient exercise modality for improving skeletal muscle and cardiovascular fitness. But the beneficial role of CRT in obese individuals is still not well understood. This study explores the reducing effects of progressive CRT on inflammatory biomarkers and cardiometabolic risk factors in obese young men. Methods: Thirty obese men (Body mass index (BMI): 30.67 3.06; age: 23 3.2 years) were divided into CRT and control groups. The CRT was performed for eight-weeks (3 times/week, 65 85% of 1 repetition maximum). Fasting blood samples were taken pre and post intervention for analyzing apelin, chemerin, serum amyloid A (SAA), C reactive protein concentrations (CRP), lipid profile, and insulin resistance index. The data were assessed by two-way repeated measures ANOVA. Results: Body mass, BMI and waist to hip ratio (WHR) were significantly decreased after training intervention (P .05). Moreover, insulin resistance was positively correlated with apelin (r = 0.56) and chemerin (r = 0.51). Also, chemerin had a positive correlation with SAA (r = 0.49), and WHR (r = 0.54). Conclusion: CRT caused an improvement in inflammation and cardiometabolic risk factors in young obese men, and this improvement was accompanied by decreased insulin resistance.Scopu