Highlights from the 2023 International Meeting on the Molecular Biology of Hepatitis B virus

Since its discovery in 1965, our understanding of the hepatitis B virus (HBV) replication cycle and host immune responses has increased markedly. In contrast, our knowledge of the molecular biology of hepatitis delta virus (HDV), which is associated with more severe liver disease, is less well understood. Despite the progress made, critical gaps remain in our knowledge of HBV and HDV replication and the mechanisms underlying viral persistence and evasion of host immunity. The International HBV Meeting is the leading annual scientific meeting for presenting the latest advances in HBV and HDV molecular virology, immunology, and epidemiology. In 2023, the annual scientific meeting was held in Kobe, Japan and this review summarises some of the advances presented at the Meeting and lists gaps in our knowledge that may facilitate the development of new therapies.

LSD1 inhibition suppresses ASCL1 and de-represses YAP1 to drive potent activity against neuroendocrine prostate cancer

Lysine-specific demethylase 1 (LSD1 or KDM1A ) has emerged as a critical mediator of tumor progression in metastatic castration-resistant prostate cancer (mCRPC). Among mCRPC subtypes, neuroendocrine prostate cancer (NEPC) is an exceptionally aggressive variant driven by lineage plasticity, an adaptive resistance mechanism to androgen receptor axis-targeted therapies. Our study shows that LSD1 expression is elevated in NEPC and associated with unfavorable clinical outcomes. Using genetic approaches, we validated the on-target effects of LSD1 inhibition across various models. We investigated the therapeutic potential of bomedemstat, an orally bioavailable, irreversible LSD1 inhibitor with low nanomolar potency. Our findings demonstrate potent antitumor activity against CRPC models, including tumor regressions in NEPC patient-derived xenografts. Mechanistically, our study uncovers that LSD1 inhibition suppresses the neuronal transcriptional program by downregulating ASCL1 through disrupting LSD1:INSM1 interactions and de-repressing YAP1 silencing. Our data support the clinical development of LSD1 inhibitors for treating CRPC - especially the aggressive NE phenotype.

Statement of Significance

Neuroendocrine prostate cancer presents a clinical challenge due to the lack of effective treatments. Our research demonstrates that bomedemstat, a potent and selective LSD1 inhibitor, effectively combats neuroendocrine prostate cancer by downregulating the ASCL1- dependent NE transcriptional program and re-expressing YAP1.

An in-depth characterisation of European seabass intestinal segments for assessing the impact of an algae-based functional diet on intestinal health

Sustainable farming of fish species depends on emerging new feed ingredients, which can alter the features of the digestive tract and influence animals' overall health. Recent research has shown that functional feeds hold great potential for enhancing fish robustness by evoking appropriate responses at the intestine level. However, there is a lack of extensive and accurate descriptions of the morphology of the gastrointestinal tract of most farmed fish. We have characterised the intestine of European seabass thoroughly, by targeting four segments - anterior, mid, posterior and rectum. Results indicated that the anterior segment is mostly associated with absorption-related features; this segment has the largest absorptive area, the longest villi, and the highest number of neutral goblet cells (GC). The posterior segment and rectum have distinct histomorphometric features, but both seem to be important for immunity, displaying the highest count of acid GC and the highest expression of immune-related genes. The strongest proliferating cell nuclear antigen (PCNA) signal was observed in the anterior intestine and rectum, with PCNA⁺ cells appearing at the base of the villi and the corresponding villi branches. We have also evaluated the impact of a novel feed supplemented with a macro- and microalgae blend and found that there were no differences in terms of growth. However, the alterations observed in the mid intestine of fish fed the blend, such as thickening of the submucosa and lamina propria, an increased number of leucocytes, and higher expression of immune- and oxidative stress-related genes, suggest that algae may have an immunomodulatory effect. In the current article, we have described the morphology and expression patterns of the intestine segments of European seabass in detail and have presented a comprehensive report of the indices and methods used for the semi-quantitative and quantitative histomorphometric assessments, thereby providing useful information for future studies that aim to maintain intestinal health through dietary interventions.

Characterization and long-term follow-up of children with brugada syndrome: experience from a tertiary paediatric referral centre

Introduction

Brugada syndrome (BrS) is an autosomal dominant channelopathy, which typically presents in young adults. It can also be diagnosed in children, but data in this age group is scarce.

Purpose

To describe the clinical features, management and long-term follow-up of children with BrS history followed-up in a tertiary paediatric referral centre.

Methods

Single centre retrospective study of consecutive patients with history of BrS, defined as having a BrS positive phenotype (BrS(+)), or a negative phenotype-positive genotype (BrS(−)). They were all followed up in a paediatric heart rhythm clinic. Clinical and demographical data were collected and analysed according to the phenotype.

Results

30 patients were included, with a median age at diagnosis of 7 years (IQR 1–13) and a mean follow-up time of 7±3 years. Sixteen patients were BrS(+), predominantly male (n=13, 81%). 88% (n=14) performed a genetic test, which was positive in 57% (n=8); the most frequent mutation was SCN5A (n=5). Family history of BrS was present in 56% (n=9) and almost one third had family history of sudden cardiac death (SCD). Most of the patients had a type 1 Brugada ECG pattern (n=14) and 2 patients presented a fever and drug induced pattern, respectively. Fourteen patients were BrS(−), mostly female (n=11, 79%) with a loss-of-function mutation in the SCN5A gene (n=10). They all had family members with BrS, mainly from the paternal side, and 43% (n=6) mentioned SCD history. Although most of the patients were asymptomatic, the prevalence of rhythm or conduction disturbances was not infrequent, particularly in BrS(+) patients (n=12, 75%). Also, in this group and during follow-up, 3 patients had documented supraventricular tachyarrhythmias, and 2 patients had syncope episodes, one of which required an implantable cardioverter-defibrillator. No events were reported in the BrS(−) patients. Nine patients (n=9/30, 30%) were hospitalized, 3 due to an arrhythmic event (all in the BrS(+) group). Overall, no sudden cardiac death event was reported during follow-up.

Conclusion

In our study, although the majority of the patients were asymptomatic, the occurrence of arrhythmic events was not negligible, especially in the BrS(+) patients. Despite the significant family history, patients with BrS(−) had no events reported during follow-up. Nevertheless, the management of these patients is not clear cut, and a personalized therapeutic strategy with close follow-up is essential.

Funding Acknowledgement

Type of funding sources: None.

Digital Interventions for Emotion Regulation in Children and Early Adolescents: Systematic Review and Meta-analysis

Background

Difficulties in emotion regulation are common in adolescence and are associated with poor social and mental health outcomes. However, psychological therapies that promote adaptive emotion regulation may be inaccessible and unattractive to youth. Digital interventions may help address this need.

Objective

The aim of this systematic review and meta-analysis was to synthesize evidence on the efficacy, feasibility, and acceptability of emotion regulation digital interventions in children and early adolescents aged 8 to 14 years.

Methods

Systematic searches of Web of Science, MEDLINE, PsycINFO, EMBASE, Education Resources Information Centre, ACM Digital Library, and IEEE Xplore up to July 2020 identified 39 studies, of which 11 (28%) were included in the meta-analyses (n=2476 participants). A bespoke tool was used to assess risk of bias.

Results

The studies evaluated digital games (27/39, 69%), biofeedback (4/39, 10%), virtual or augmented reality (4/39, 10%), and program or multimedia (4/39, 10%) digital interventions in samples classified as diagnosed, at risk, healthy, and universal. The most consistent evidence came from digital games, which reduced negative emotional experience with a small significant effect, largely in youth at risk of anxiety (Hedges g=–0.19, 95% CI –0.34 to –0.04). In general, digital interventions tended to improve emotion regulation, but this effect was not significant (Hedges g=0.19, 95% CI –0.16 to 0.54).

Conclusions

Most feasibility issues were identified in diagnosed youth, and acceptability was generally high across intervention types and samples. Although there is cause to be optimistic about digital interventions supporting the difficulties that youth experience in emotion regulation, the predominance of early-stage development studies highlights the need for more work in this area.

The Use of Thromboelastography in Percutaneous Coronary Intervention and Acute Coronary Syndrome in East Asia: A Systematic Literature Review

Dual antiplatelet therapy (DAPT), alongside percutaneous coronary intervention (PCI), is central to the prevention of ischemic events following acute coronary syndrome (ACS). However, response to therapy can vary due to several factors including CYP2C19 gene variation, which shows increased prevalence in East Asian populations. DAPT responsiveness can be assessed using techniques such as light transmission aggregometry (LTA), VerifyNow^® and thromboelastography with the PlateletMapping^® assay, and there is increasing focus on the utility of platelet function testing to guide individualized treatment. This systematic literature review of one English and three Chinese language databases was conducted to evaluate the evidence for the utility of thromboelastography in ACS/PCI in East Asia. The search identified 42 articles from the English language and 71 articles from the Chinese language databases which fulfilled the pre-determined inclusion criteria, including 38 randomized controlled trials (RCTs). The identified studies explored the use of thromboelastography compared to LTA and VerifyNow in monitoring patient responsiveness to DAPT, as well as predicting ischemic risk, with some studies suggesting that thromboelastography is better able to detect low DAPT response than LTA. Other studies, including one large RCT, described the use of thromboelastography in guiding the escalation of DAPT, with some evidence suggesting that such protocols reduce ischemic events without increasing the risk of bleeding. There was also evidence suggesting that thromboelastography can be used to identify individuals with DAPT hyporesponsiveness genotypes and could potentially guide treatment by adjusting therapy in patients depending on responsiveness.

1001 Intra-Articular Distal Radius Fracture Surgical Intervention Threshold Origins and Development

Background

Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is > 2mm; this value is often used as an indication for surgery if closed reduction is not possible.

Method

A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present.

Results

Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with >2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation.

Conclusions

Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.

Nutritional value and sensory properties of common carp (Cyprinus carpio L.) fillets enriched with sustainable and natural feed ingredients

Declines across global fishery stocks forced aquaculture feed manufacturers to search for new and sustainable components. Therefore, the aim of study was assessing nutritional value and sensory properties of meat of common carp (Cyprinus carpio L.) fed for 116 days with two blends. The control feed contained 5% of fishmeal and vegetable oils (rapeseed and soybean) as sole fat sources. While in the experimental diet half of the fishmeal was replaced with a blend of microalgae (Spirulina sp., Chlorella sp.), macroalgae (Laminaria digitata) and vegetable oil was replaced with salmon oil. Proximate composition, energy value, fatty acid profile of meat, nutritional characteristics of fat and protein as well as culinary properties of fillets were assessed. Fillets of carp fed experimental diet had a higher level of protein, lower level of fat and energy value. Intramuscular fat of fish fed with the experimental diet had a better parameters of quality. Protein in the meat of fish from both groups was characterized by a high quality comparing to the protein standard. Our study showed that meat of carp fed with experimental feed enriched with sustainable and natural feed ingredients can be a sensorily attractive source of nutritious ingredients in the human diet.

Plasma biochemistry, gene expression and liver histomorphology in common carp (Cyprinus carpio) fed with different dietary fat sources

Demand for omega-3 long chain polyunsaturated fatty acids has become global challenge for aquaculture and different components have been used to increase nutritional value of fillets. The aim of this study was to evaluate influences of feeds on zootechnical parameters, biochemical plasma parameters, expression of lipid-dependent genes, hepatocyte histomorphologies, and fatty acid profiles in common carp fillets. We compared a control diet (CTRL), mimicking a commercial feed formulation for common carp, with three diets containing blends of vegetable oils and a DHA-rich alga (Schizochytrium sp.) included at 3.125% (CB1) or 1.563% (CB2), and 2.1% salmon oil (CB3). The study revealed no differences in final body weight of fish fed CB1-3 diets in comparison with significantly lower CTRL. Concentrations of all biochemical parameters in plasma increased gradually in fish fed CB1-3 diets when compared to CTRL diet, with exception of triacylglycerol levels. Expression of hepatic fas, elovl-5a and pparα genes increased significantly in fish fed CB1 and CB2. Additionally, eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) accumulation in muscle tissue was directly proportional to the amounts supplied in the diets. Our study revealed that carp fillet profiles can be manipulated for DHA and EPA-contents using enriched diets, depending on the source of fat.

Dietary tryptophan deficiency and its supplementation compromises inflammatory mechanisms and disease resistance in a teleost fish

Tryptophan participates on several physiological mechanisms of the neuroendocrine-immune network and plays a critical role in macrophages and lymphocytes function. This study intended to evaluate the modulatory effects of dietary tryptophan on the European seabass (Dicentrarchus labrax) immune status, inflammatory response and disease resistance to Photobacterium damselae piscicida. A tryptophan deficient diet (NTRP); a control diet (CTRL); and two other diets supplemented with tryptophan at 0.13% (TRP13) and 0.17% (TRP17) of feed weight were formulated. Fish were sampled at 2 and 4 weeks of feeding and the remaining were i.p. injected with Phdp (3 × 10⁶ cfu/fish) at 4 weeks and the inflammatory response (at 4, 24, 48 and 72 hours post-infection) as well as survival were evaluated. Results suggest that fish immune status was not altered in a tryptophan deficient scenario whereas in response to an inflammatory insult, plasma cortisol levels increased and the immune cell response was compromised, which translated in a lower disease resistance. When dietary tryptophan was offered 30% above its requirement level, plasma cortisol increased and, in response to bacterial infection, a decrease in lymphocytes, monocytes/macrophages and several immune-related genes was observed, also compromising at some degree fish disease resistance.

Under-reporting bicycle accidents to police in the COST TU1101 international survey: Cross-country comparisons and associated factors

Police crash reports are often the main source for official data in many countries. However, with the exception of fatal crashes, crashes are often underreported in a biased manner. Consequently, the countermeasures adopted according to them may be inefficient. In the case of bicycle crashes, this bias is most acute and it probably varies across countries, with some of them being more prone to reporting accidents to police than others. Assessing if this bias occurs and the size of it can be of great importance for evaluating the risks associated with bicycling. This study utilized data collected in the COST TU1101 action "Towards safer bicycling through optimization of bicycle helmets and usage". The data came from an online survey that included questions related to bicyclists' attitudes, behaviour, cycling habits, accidents, and patterns of use of helmets. The survey was filled by 8655 bicyclists from 30 different countries. After applying various exclusion factors, 7015 questionnaires filled by adult cyclists from 17 countries, each with at least 100 valid responses, remained in our sample. The results showed that across all countries, an average of only 10% of all crashes were reported to the police, with a wide range among countries: from a minimum of 0.0% (Israel) and 2.6% (Croatia) to a maximum of a 35.0% (Germany). Some factors associated with the reporting levels were type of crash, type of vehicle involved, and injury severity. No relation was found between the likelihood of reporting and the cyclist's gender, age, educational level, marital status, being a parent, use of helmet, and type of bicycle. The significant under-reporting - including injury crashes that do not lead to hospitalization - justifies the use of self-report survey data for assessment of bicycling crash patterns as they relate to (1) crash risk issues such as location, infrastructure, cyclists' characteristics, and use of helmet and (2) strategic approaches to bicycle crash prevention and injury reduction.

Are radiographic measurements of the displacement of a distal radial fracture reliable and reproducible?

AIMS

The degree of displacement of a fracture of the distal radius is an important factor which can be assessed using simple radiographic measurements. Our aim was to investigate the reliability and reproducibility of these measurements and to determine if they should be used clinically.

PATIENTS AND METHODS

A 10% sample was randomly generated from 3670 consecutive adult patients who had presented to University Hospitals of Leicester NHS Trust between 2007 and 2010 with a fracture of the distal radius. Radiographs of the 367 patients were assessed by two independent reviewers. Four measurements of displacement of the fracture were recorded and the inter-observer correlation assessed using the intra-class correlation coefficient.

RESULTS

Inter-observer correlation was high (> 0.8) for three of the four measurements. Repeat measurements of a further randomly generated 10% sample (37) were made four weeks later to assess intra-observer agreement, which was again high (> 0.8) for the same three parameters (radial height, radial inclination and dorsal/palmar tilt). Correlation was poor for articular step and gap.

CONCLUSION

Radiographic assessment of radial angle, radial inclination and dorsal/palmar tilt is a reliable method of determining the degree of displacement of a fracture of the distal radius. Cite this article: Bone Joint J 2016;98-B:1069-73.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Automatic attentional processing of faces with disease cues

Introduction

Stimuli that are relevant to our survival, especially those that signal the presence of a threat in the environment (e.g., threatening faces), automatically attract our attention.

Objective

The same may be true for faces displaying subtle disease cues as they may signal danger of potential contamination and, hence, disease-avoidance behaviour, which was the focus of the present research.

Aim

The present study investigated, for the first time to our knowledge, whether faces with disease cues (DF), compared to control stimuli (faces without such cues) (CF), interfered with the participants’ performance in a letter discrimination task.

Method

Eighty-six (44 women) university students volunteered to participate in a letter discrimination task where 240 DF and 240 CF were presented.

Results

The results confirmed our hypothesis by showing that for DF, compared to CF, participants took longer to discriminate the target letters. Moreover, the results from a further rating task showed that DF, compared to CF, were rated as significantly more disgusting and associated with disease, thus confirming our experimental manipulation and suggesting that disgust may be driving automatic attention to DF.

Conclusions

Our findings provide important insights on the possible influence of exogenous attention to disease cues in social avoidance behaviour, which may have relevant implications in clinical disorders with disgust at its core.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Health care costs attributable to overweight calculated in a standardized way for three European countries

This article presents a tool to calculate health care costs attributable to overweight in a comparable and standardized way. The purpose is to describe the methodological principles of the tool and to put it into use by calculating and comparing the costs attributable to overweight for The Netherlands, Germany and Czech Republic. The tool uses a top-down and prevalence-based approach, consisting of five steps. Step one identifies overweight-related diseases and age- and gender-specific relative risks. Included diseases are ischemic heart disease, stroke, hypertension, type 2 diabetes mellitus, colorectal cancer, postmenopausal breast cancer, endometrial cancer, kidney cancer and osteoarthritis. Step two consists of collecting data on the age- and gender-specific prevalence of these diseases. Step three uses the population-attributable prevalence to determine the part of the prevalence of these diseases that is attributable to overweight. Step four calculates the health care costs associated with these diseases. Step five calculates the costs of these diseases that are attributable to overweight. Overweight is responsible for 20-26% of the direct costs of included diseases, with sensitivity analyses varying this percentage between 15-31%. Percentage of costs attributable to obesity and preobesity is about the same. Diseases with the highest percentage of costs due to overweight are diabetes, endometrial cancer and osteoarthritis. Disease costs attributable to overweight as a percentage of total health care expenditures range from 2 to 4%. Data are consistent for all three countries, resulting in roughly a quarter of costs of included diseases being attributable to overweight.

Bilateral shared autonomous systems with passive and nonpassive input forces under time varying delay

In this paper, we address stability and tracking control problem of bilateral shared autonomous systems in the presence of passive and nonpassive input interaction forces. The design comprises delayed position and position-velocity signals with the known and unknown structures of the master and slave manipulator dynamics. Using novel Lyapunov-Krasovskii functional, stability and tracking conditions of the coupled master-slave shared autonomous systems are developed under symmetrical and unsymmetrical time varying data transmission delays. This condition allows the designer to estimate the control design parameters to ensure position, velocity and synchronizing errors of the master and slave manipulators. Finally, evaluation results are presented to demonstrate the validity of the proposed design for real-time teleoperation applications.

Adult circumcision and male sexual health: a retrospective analysis

We aimed to evaluate possible associations of circumcision with several sexual dysfunctions and to identify predictors for the development of these outcomes post-operatively. Telephone surveys about sexual habits and dysfunctions before and after intervention were conducted post-operatively to patients that underwent circumcision in Centro Hospitalar Vila Nova de Gaia/Espinho during 2011. McNemar test was used for a matched-pairs analysis of pre- and post-operative data. Odds ratios, adjusted in a multivariate analysis, explored predictors of de novo sexual dysfunctions after circumcision. With intervention, there was an increase in frequency of erectile dysfunction (9.7% versus 25.8%, P = 0.002) and delayed orgasm (11.3% versus 48.4%, P < 0.001), and a significant symptomatic improvement in patients with pain with intercourse (50.0% versus 6.5%, P < 0.001). Significant predictors for de novo erectile dysfunction were diabetes mellitus (OR 9.81, P = 0.048) and lack of sexual desire (OR 8.76, P = 0.028). Less than three sex partners (OR 7.04, P = 0.007) and low sexual desire (OR 7.49, P = 0.029) were significant predictors for de novo delayed orgasm.

[Impact of foot reconstruction surgery on the daily life of patients with cerebrovascular accident sequelae]

OBJECTIVE

The equinovarus deformity of the foot and digital scrolling is very common among people with sequelae from cerebrovascular accidents. The aim of this study was focused on changes produced by surgical correction of the deformity in terms of comfort, balance, independence and ability to move freely within the context of the daily life of the patient.

MATERIAL AND METHODS

The data was evaluated using a retrospective survey and a prospective analysis of gait habits using a recording walking device (WalkinSense(®)) before and after surgery. All the 15 patients enrolled in the study were submitted to similar surgical procedures of lengthening and tendon transfers.

RESULTS

The use of technical aids to correct the deformity and to aid in walking, as well as painful calluses and difficulties with the shoes and walking on uneven surfaces, decreased significantly. Quantitative analysis of the gait showed that after surgery the patient started to move with smaller steps, although with a higher cadence. Gait analysis also revealed a decrease in the amount of gait segments and speed.

DISCUSSION AND CONCLUSIONS

The results showed a positive development in terms of indicators of comfort, balance, independence and self-image through surgery. However the new way of walking seems to be more tiring for the patients, which could justify a decrease in the number of gait segments and speed.

Safety of dilation in adults with eosinophilic esophagitis

Esophageal dilation is an effective therapy for dysphagia in patients with stenosing eosinophilic esophagitis (EoE). Historically, there have been significant concerns of increased perforation rates when dilating EoE patients. More recent studies suggest that improved techniques and increased awareness have decreased complication rates. The aim of this study was to explore the safety of dilation in our population of EoE patients. A retrospective review of all adult EoE patients enrolled in a registry from 2006 to 2010 was performed. All patients who underwent esophageal dilation during this time period were identified and included in the analysis. Our hospital inpatient/outpatient medical records, radiology reports, and endoscopy reports were searched for evidence of any complication following dilation. Perforation, hemorrhage, and hospitalization were identified as a major complication, and chest pain was considered a minor complication. One hundred and ninety-six patients (41 years [12]; mean age [standard deviation], 80% white, 85% male) were identified. In this cohort, 54 patients (28%) underwent 66 total dilations (seven patients underwent two dilations, one patient underwent three dilations, and one patient underwent four dilations). Three dilation techniques were used (Maloney [24], Savary [29] and through-the-scope [13]). There were no major complications encountered. Chest pain was noted in two patients (4%). There were no endoscopic features (rings, furrows, plaques) associated with any complication. Type of dilator, size of dilator, number of prior dilations, and age of patient were also not associated with complications. Endoscopic dilation using a variety of dilators can be safely performed with minimal complications in patients with EoE.

Dupuytren's disease presentation, referral pathways and resource utilisation in Europe: regional analysis of a surgeon survey and patient chart review

AIM

We explored the management of Dupuytren's disease (DD) using a surgeon survey and patient chart review.

METHODS

Twelve countries participated: Denmark, Finland, Sweden (Nordic region); Czech Republic, Hungary, Poland (East); France, Germany, the Netherlands, United Kingdom (West); Italy, Spain (Mediterranean). A random sample of orthopaedic/plastic surgeons (N = 687) with 3-30 years' experience was asked about Dupuytren's contracture procedures performed during the previous 12 months. Information ≤ 5 consecutive patients per surgeon was extracted from patient charts (N = 3357).

RESULTS

Overall, 84% of participants were orthopaedic surgeons; 56% of surgeons were hand specialists. Deciding factors for fasciectomy and dermofasciectomy were consistent across regions: metacarpophalangeal (MP) or proximal interphalangeal contracture > 45°, recurrent contracture, and high expectations for success. Deciding factors for percutaneous needle fasciotomy were less consistent across regions, but the leading factor was MP flexion < 20°. Overall, 49% of diagnoses and 55% of referrals were made by a general practitioner (GP), with regional variation: 31-77% for GP diagnoses and 36-81% for GP referrals. There were also differences in admission status (e.g. 9% of Nordic patients and 80% of Eastern patients were treated as inpatients). Most patients were treated in public hospitals and most procedures were covered by public health insurance.

CONCLUSIONS

We found regional variations in surgical practice, patient characteristics and referral patterns. Understanding current diagnosis and treatment patterns, in relation to regional differences in health economics, may improve physicians' diagnosis of DD and guide patients towards appropriate, customised management plans.

Surgical management of Dupuytren's contracture in Europe: regional analysis of a surgeon survey and patient chart review

AIM

We explored regional variations in the surgical management of patients with Dupuytren's contracture (DC) in 12 European countries using a surgeon survey and patient chart review.

METHODS

Twelve countries participated: Denmark, Finland, Sweden (Nordic region); Czech Republic, Hungary, Poland (East); France, Germany, the Netherlands, UK (West); Italy, Spain (Mediterranean). For the survey, a random sample of orthopaedic/plastic surgeons (n = 687) with 3-30 years' experience was asked about DC procedures performed during the previous 12 months. For the chart review (n = 3357), information from up to five consecutive patients was extracted. Descriptive statistics are reported.

RESULTS

Ninety-five per cent of all surgeons used fasciectomy for DC, followed by fasciotomy (70%), dermofasciectomy (38%) and percutaneous needle fasciotomy (35%). Most surgeons were satisfied with fasciectomy over other procedures. Recommended time away from work and duration of physical therapy increased with the invasiveness of the procedure. The intra-operative complication rate was 4.0%; the postoperative complication rate was 34%. Overall, ≥ 97% of the procedures were rated by surgeons as having a positive outcome. Across all regions, 54% of patients had no nodules or contracture after the procedures. Only 2% of patients required retreatment within the first year of surgery. Important inter- and intraregional differences in these aspects of patient management are described.

CONCLUSIONS

Understanding current regional treatment patterns and their relationships to country-specific health systems may facilitate earlier identification of, and intervention for, DD and help to optimise the overall treatment for patients with this chronic condition.