Queen Elizabeth University Hospital

Abstract Introduction The vascular surgery population is becoming increasingly frail. Frailty is defined either by the cumulative deficit model or the frailty phenotype. The cumulative deficit model describes frailty as the progressive accumulation of deficits that increase a patient's risk of adverse outcomes. The frailty phenotype is a biological syndrome characterised by physical decline across five domains: weight loss, exhaustion, low activity, slowness, and weakness. There is currently no consensus on the optimal method for assessing frailty in vascular surgical patients. Methods Patients presenting with CLTI were enrolled from our rapid-access clinic between November 2024 and May 2025. Each patient was assessed using the FFP, CFS, and ‘End-of-bed Test’ (EoB). Frailty was defined as FFP ≥3 or CFS ≥5. Correlation was calculated using Spearman’s rank and interrater reliability was assessed with Cohen’s Kappa. Results 139 patients were included. Frailty was identified in 96 (69.1%) using FFP, 94 (67.6%) using CFS, and 100 (71.9%) using EoB. A positive correlation was observed between FFP and CFS (ρ = 0.512, P < 0.001) with moderate agreement (κ = 0.402, P < 0.001). The weakest correlation was between FFP and EoB (ρ = 0.368, P < 0.001) with fair agreement (k = 0.343, P < 0.001) and the strongest between CFS and EoB (ρ = 0.739, P < 0.001) with almost perfect agreement (k = 0.830, P < 0.001). Conclusions Both the CFS and FFP are suitable for use in vascular surgery patients. Further outcome-based analysis is ongoing to determine the most predictive tool for clinical use.

Traumatic brachial plexus injuries (TBPI) are life-changing and can lead to permanent changes in function and pain within the arm and hand. Historically, TBPI research has reflected the priorities of researchers and clinicians rather than those with personal experience of living with a TBPI. The James Lind Alliance (JLA), supported by the National Institute for Health Research, has developed a rigorous methodology for increasing public engagement in research by giving an equal voice to patients, carers, and healthcare providers to ensure that their concerns are represented in future health research programmes. These projects are called priority setting partnerships (PSPs). A JLA PSP, comprising patients, carers and clinicians, was created and completed to agree future research priorities in adult TBPI. The JLA PSP methodology was followed throughout. One-hundred and fifty-four respondents replied to an initial survey generating 704 questions. These were assessed, grouped and combined to create 68 summary questions or 'uncertainties'. Three were excluded after literature review suggested they had already been answered by research. Seventy-nine respondents answered an interim prioritization survey, choosing their top ten from the summary questions. In a workshop, nine patients, two carers and 11 clinicians met, discussed and ranked the top 22 questions from the interim survey to identify the top 10 research priorities. Psychology, physical therapy treatments and management pathways were among the top ranked priorities. These results will inform researchers and funding bodies about research priorities for patients, carers and clinicians to direct future research on TBPI. V.

A descriptive quantitative study. To determine how much and what type of exercises and training were provided as part of usual physiotherapy and occupational therapy to participants of the SCI-MT Trial (the Early and Intensive Motor Training for People with Spinal Cord Injuries Trial). This information is important because the SCI-MT Trial concluded that additional motor training is redundant if people with SCI receive equivalent usual care as what was provided to participants of the SCI-MT Trial. Fifteen spinal injury units across Europe and Australia. Data were collected on the time participants of both groups of the SCI-MT Trial (n = 220) attended physiotherapy and occupational therapy provided as part of usual care over the 10-week intervention period. The International Spinal Cord Injury Physical Therapy and Occupational Therapy Basic Data Set was used to capture time spent on activity and impairment directed categories of exercises and training. Participants attended a median (interquartile range) of 8.3 (6.2 to 11.4) hours of physiotherapy and occupational therapy per week. Approximately 70% of therapy time was spent actively exercising or training with a median of 3.8 h per week spent on activity-directedand 1.9 h per week spent on impairment-directedexercises and training. The results of this study detail the amount and type of physiotherapy and occupational therapy that needs to be provided as part of usual rehabilitation care to render additional motor training redundant.

Background: Iron deficiency (ID) is common among people with chronic kidney disease (CKD) and/or heart failure (HF). Despite the additional burden ID causes among people with CKD and HF, there is considerable uncertainty surrounding the best way to diagnose it and, subsequently, identify who is most likely to benefit from receiving iron therapy. Methods: This manuscript reports the markers and thresholds used in ID diagnosis, treatment, and management in the UK by nephrologists and cardiologists who manage people with chronic kidney disease or heart failure, as well as investigating future challenges and questions that remain unanswered. The research involved three stages: an online questionnaire, individual interviews, and a panel meeting, which discussed the findings from the first two stages. Results: The panel concluded that there is no robust definition of iron deficiency that can be applied to chronic kidney disease and heart failure. Existing methods of diagnosing iron deficiency come with various problems; a transferrin saturation of <20% is the most popular, but it is not regarded as a perfect solution. Transferrin saturation is also the most popular way of assessing the success of iron deficiency treatment. Clinicians generally do not vary treatment regimens based on severity or subgroups. There are large variations in monitoring and the ability to administer iron therapy in secondary care. Conclusions: There is a clear need to consolidate current approaches to diagnosing and treating iron deficiency in people with chronic kidney disease and/or heart failure. Simple markers and thresholds, and simple strategies to implement them are required.

The global incidence of spinal cord injury (SCI) is between 10 and 80 new cases per million people each year. This equates to between 250,000 and 500,000 injuries worldwide per year. In the United Kingdom, approximately 4400 people per year sustain an SCI. People with tetraplegia report upper limb function as their highest priority for improvement after SCI. Using immersive virtual reality (VR) headsets, physical rehabilitation exercises can be completed in engaging digital environments. Immersive VR therefore has the potential to increase the amount of therapy undertaken, leading to improvements in arm and hand function. There is little evidence supporting immersive VR as exercise in SCI, especially while patients with SCI are undergoing acute rehabilitation. In SCI research, co-design of new interventions is not a widely adopted approach, yet people with tetraplegia want to contribute with their expert knowledge on their experiences of SCI. This study aims to explore the lived experiences of people with tetraplegia and specialist SCI therapists related to acute upper limb rehabilitation and identify design considerations for VR-based interventions targeting the upper limb. We conducted 7 online focus groups using Microsoft Teams: 4 with people with tetraplegia (n=15; age range, 36-65 years) and 3 with occupational therapists and physiotherapists specializing in SCI rehabilitation (n=11). Participants were asked to discuss their experiences and expertise about acute SCI upper limb rehabilitation and their opinions and ideas on the use of VR for upper limb rehabilitation. The transcripts were analyzed using content analysis, enabling the proposition of design characteristics of a VR-based intervention for upper limb exercise. The study identified 5 major themes describing the clinical features, treatment, and recovery of people with SCI during the acute stage of SCI, their motivations for participating in therapy, and suggestions for the design of a VR intervention in treating the upper limbs following SCI. The themes identified in this study allow the elicitation of software requirements for a bespoke immersive VR platform for upper limb rehabilitation following SCI. They can also contribute to a better understanding of the advantages of using VR as an adjunct to upper limb rehabilitation. Additionally, participants used their expertise to suggest factors that would enable the development of a usable and effective intervention, as well as identifying potential pitfalls and software features to avoid during intervention development. These findings can be used to design accessible VR applications for use by people with tetraplegia and their therapists.

Fig. 1 Currently, treatments for Leber Hereditary Optic Neuropathy (LHON) are few with limited efficacy.Because the disease has a welldefined genetic cause and retinal ganglion cells are relatively accessible, gene therapy delivered by intravitreal injection is viewed as a promising therapeutic strategy [1]. This infographic summarises the design and results of the REFLECT Trial.This trial was a multicentre, double-masked, randomised, sham-controlled trial evaluating the unilateral versus bilateral use of the gene therapy rAAV2/2-ND4.All patients' first-affected eyes received gene therapy, whilst patients were allocated either a sham intervention or further gene therapy in the second/not-yet affected eye.The primary outcome was change from baseline logMAR in the second/not-yet affected eye.The trial showed no statistically significant improvement in the primary outcome in both treated and non-treated second/not-yet affected eyes at 18 months, with both trial arms demonstrating minor improvement.The treatment effect was greater in patients who received bilateral treatment and there were no increased safety risks identified [2].

To investigate the value of baseline CT imaging for the prediction of functional outcome and benefit of endovascular thrombectomy (EVT) for anterior large vessel occlusion (LVO). We used individual patient data from seven randomized EVT trials and included patients with available baseline CT imaging and outcome data. We developed a model to predict functional outcome and benefit of EVT, including baseline stroke-related and brain frailty CT imaging features alone. We compared the discriminative performance of our model for predicting good functional outcome (modified Rankin Scale [mRS] 0-2) and treatment benefit (difference between the probability of mRS 0-2 with vs without EVT) with MR PREDICTS by calculating the difference in C-statistics (delta C and delta C-for-benefit). We included 1391 patients (median age, 67 years, interquartile range 59-76; 53% male). Discrimination of the model based on CT imaging alone was substantial for the prediction of good functional outcome (C-statistic 0.700, 95% CI: 0.666-0.731) and treatment benefit (C-for-benefit 0.640, 95% CI: 0.586-0.690). After adding the known strongest clinical predictors namely age and National Institutes of Health Stroke Scale score, discrimination improved to slightly lower than MR PREDICTS for prediction of good functional outcome (C-statistic 0.733 vs 0.750; delta C, -0.017 [95% CI: -0.037 to 0.003]) and treatment benefit (C-for-benefit 0.675 vs 0.692; delta C-for-benefit -0.017 [95% CI: -0.084 to 0.050]). Baseline CT imaging holds considerable predictive value with regard to functional outcome and treatment benefit, but a combination of clinical and imaging features offers the best predictive performance. Question The predictive value of baseline CT imaging for the prediction of functional outcome and benefit of EVT for anterior LVO stroke is uncertain. Findings Discrimination of a model based on CT imaging alone is substantial, but can further be improved by the addition of limited clinical characteristics. Clinical relevance Baseline CT imaging holds considerable predictive value with regard to functional outcome and treatment benefit. The addition of limited clinical information is needed to achieve predictive performance similar to an established prediction model.

Abstract Background Excess fat mass and myopenia have been associated with adverse disease outcomes in Crohn’s disease (CD). Despite increasing use of advanced therapies in CD, tools that predict treatment response are lacking. We explored if body composition could predict response to standard-dose adalimumab in active CD. Methods This was a secondary analysis of BIOPIC study, a multicentre randomised controlled trial investigating the effect of partial enteral nutrition in patients with active CD commencing adalimumab therapy. Anthropometry and body composition (bioelectrical impedance analysis, Tanita DC-360P) was measured. Fat mass and fat-free mass were standardised for height (body fat index-BFI and fat-free mass index-FFMI). Patient follow-up was undertaken at 6 and 12 weeks to assess response to adalimumab. Clinical response or remission was assessed by Harvey-Bradshaw Index (HBI) and defined as reduction in HBI ≥ 3 or HBI &amp;lt; 5. Biochemical response (CRP &amp;lt;10) and faecal calprotectin (FCAL) normalisation (&amp;lt;200) were assessed. Therapeutic adalimumab drug levels and anti-drug antibodies (ADAs) were measured. Treatment outcomes and body composition parameters were analysed using logistic regression. Results Seventy-eight participants were included (mean age 40.8 [SD 14.5], 41 (53%) female). Baseline BFI (OR 1.24, CI 1.09-1.41, p = 0.001) and fat mass (OR 1.12, CI 1.05-0.19, p = &amp;lt;0.001) were significant predictors of failure to achieve response or remission to adalimumab by week 12 using a univariate logistic regression model; FFMI was not (OR 1.20, CI 0.98-1.46, p = 0.082). There was no correlation between body composition and baseline disease severity indices or biomarkers. Fat mass and BFI remained predictors of failure to achieve response or remission (OR 1.16, CI 1.07-1.26, p = 0.001, OR 1.27, CI 1.03-1.47, p = 0.002 respectively) after adjusting for disease duration, disease severity (HBI), sex and corticosteroid use. Fat mass also predicted failure to normalise CRP (OR 1.07, CI 1.01 – 1.13, p = 0.025) but body composition parameters could not predict normalisation of FCAL. Sixty-six participants had adalimumab drug levels and ADAs measured. Fat mass (%) was negatively correlated with adalimumab drug levels (r = -0.409, p &amp;lt; 0.001), positively correlated with ADAs (r = 0.300, p = 0.014) and predicted formation of ADAs to adalimumab (OR 1.07, CI 1.00-1.15, p = 0.043). Conclusion Adiposity predicts risk of treatment failure with standard dose adalimumab. This may be related to suboptimal therapeutic drug levels and increased risk of immunogenicity. Intensive monitoring of therapeutic drug levels and adjustment of adalimumab dose according to adiposity may be considered. Conflict of interest: Dr. Fattah, Sharif: No conflict of interest White, Bernadette: No conflict of interest Campbell, Iona: No conflict of interest Fandinga, Catarina: No conflict of interest Clowe, Jennifer: No conflict of interest Brownson, Emily: No conflict of interest Ho, Gwo-Tzer: No conflict of interest Robertson, Elaine: No conflict of interest Mowat, Craig: No conflict of interest Gaya, Daniel: No conflict of interest Kefayat, Amirhosein: No conflict of interest Din, Shahida: No conflict of interest Seenan, John Paul: No conflict of interest Macdonald, Jonathan: No conflict of interest Gerasimidis, Konstantinos: Grant: Nestle Health Science, Nutricia-Danone, Mylan Personal Fees: Abbott, Baxter, Nestle Health Science, Nutricia-Danone, Servier, Janssen