Conservative Treatment Research Articles

Predictive accuracy of machine learning models for conservative treatment failure in thoracolumbar burst fractures

Predictive accuracy of machine learning models for conservative treatment failure in thoracolumbar burst fractures

Evidence Supporting Conservative Scar Management Interventions Following Burn Injury: a review article.

Conservative management for hypertrophic scars (HSc) and scar contractures is of utmost importance to optimally reintegrate burn survivors into society. Many conservative treatment interventions have been described in the literature for the management of HSc. Recent advancements in the literature pertaining to post-burn scarring and HSc formation, have advanced our understanding of the mechanisms that support or refute the use of common rehabilitation treatment modalities after burn injury. This is particularly relevant for recent advancements in the fields of mechanotransduction and neurogenic inflammation resulting in the need for rehabilitation clinicians to reflect upon commonly employed treatment interventions. The aim of this review article is to summarize and clinically apply the evidence that supports or refutes the use of common conservative treatment interventions for scar management employed after burn injury. The following treatments are discussed and mechanotransduction and neurogenic inflammation concepts are highlighted: 1) edema management (compression, positioning/elevation, pumping exercises, retrograde massage, manual edema mobilization), 2) pressure therapy (including custom fabricated pressure garments, inserts, face masks, and other low-load long duration orthotic devices), 3) gels or gel sheets, 4) combined pressure therapy and gels, 5) serial casting, 6) scar massage, and 7) passive stretching. This review supports the following statements: 1) Compression for edema reduction should be initiated 48-72 hrs post-injury and continued for wounds that require longer than 21 days to heal until scar maturation; 2) Elevation, pumping exercises and retrograde massage/MEM should be used in combination with other edema management techniques; 3) Custom fabricated pressure garments should be applied once the edema is stabilized and adequate healing has occurred. Garments should be monitored on a regular basis to ensure that optional pressure, >15mm Hg, is maintained, adding inserts when necessary. The wearing time should be >16 hrs/day; 4) Gels for post-burn scar management should extend beyond the scar; 5) Serial casting should be applied when contractures interfere with function; 6) Forceful scar massage should be avoided early in the wound healing process or when the scar is inflamed or breaks down; 7) Other treatment modalities should be prioritized over passive stretching for scar management.

Energy‐Aware Power Control Scheme For Water Quality Monitoring Systems

ABSTRACTThis research introduces an innovative power management approach for wireless sensor networks in aquatic environmental monitoring. The study presents a dynamic algorithm that optimizes energy consumption in long range (LoRa) communication nodes by adaptively adjusting transmission power based on sensor–gateway distances. Leveraging GPS data and a log‐normal shadowing model, the method enables efficient power allocation. Field testing in an aquaculture setting demonstrates the energy‐aware power control (EAPC) algorithm's efficacy. Nodes at 500 m from gateways achieve up to 39% reduction in power consumption compared to fixed‐power systems. At 1250 m, savings decrease to 22%, and at 1500 m, to 11%, while maintaining reliable communication. This research advances sustainable aquatic resource management, offering applications in aquaculture, environmental conservation, and water resource management. By optimizing power usage, the approach contributes to more effective long‐term monitoring of aquatic environments.

Five-year retrospective analysis of Bakri balloon tamponade for obstetric haemorrhage and patient survey at a single tertiary centre.

Intrauterine balloon tamponade (IUBT), specifically the usage of Bakri balloon tamponade (BBT), is an effective conservative management technique for postpartum haemorrhage (PPH). The primary objective was to evaluate local guidelines and contribute to evidence regarding ideal duration for BBT. The secondary objectives were to consider impacts on maternal-foetal wellbeing, and optimise healthcare efficiency by reducing length of ICU admissions. This five-year retrospective case series analysed 132 cases of obstetric ICU admissions requiring Bakri balloon insertion for PPH within our centre. Additionally, a prospective patient experience survey was conducted over six-month period, involving 22 obstetric patients who required unplanned ICU admissions. Bakri balloon insertion was successful in 95%, whilst 5% experienced failure, necessitating further interventions (uterine artery embolisation) or return to theatre (hysterectomy). The success group demonstrated significant reductions in median blood loss (1.8 L vs. 2.5 L, p = 0.016) and difference in median duration of BBT (18.3 vs. 3.92 hours, p = 0.001). The prospective patient survey revealed a high level of satisfaction of care. Approximately 50% breastfed prior to discharge, on average commencing 23.4 hours post-delivery. This study demonstrates a high success rate of BBT, with failures typically occurring within median duration 3.9 hours. Considering the separation of mother from baby during the Bakri balloon's presence in ICU, we propose timely removal at around six hours, as failures are unlikely post this timeframe, or nursing these women in a neonatal care setting to facilitate earlier mother-baby bonding.

Effect of Radial Extracorporeal Shockwave Therapy on Pain Intensity Level in Patient with Calcaneal Spur

Background: Heel pain is a common musculoskeletal issue that significantly impacts patient daily activities and, consequently, their quality of life. This clinical study aims to evaluate the effectiveness of radial extracorporeal shockwave therapy in reducing pain intensity in patients with calcaneal spurs.Objective: To investigate the effects of radial extracorporeal shockwave therapy on pain intensity in patient with calcaneal spur.Methods: A total of 60 patients diagnosed with calcaneal spurs based on clinical examination and lateral radiography between September 2022 and June 2023 were included in this study. Participants were randomly assigned to two groups: Group A (radial extracorporeal shockwave therapy) and Group B (traditional physical therapy). All participants followed an exercise program; however, those in Group A received six sessions of radial extracorporeal shockwave therapy (10 Hz, 2000 pulses, at 2.4 bar). The Visual Analog Scale (VAS) was used to assess pain intensity both before and after treatment in all participants.Results: No significant differences were observed between Group A and Group B regarding gender, affected side, condition distribution, age, weight, height, or BMI (p > 0.05). Both groups experienced significant reductions in VAS scores post-treatment (p < 0.001); however, Group A demonstrated a greater improvement, with a percentage reduction in pain of -50.65%, compared to -28.17% in Group B. Additionally, post-treatment VAS scores were significantly lower in Group A than in Group B (p = 0.003), indicating that shockwave therapy yielded a more substantial reduction in painConclusions: Both radial extracorporeal shockwave therapy and traditional physical therapy programs significantly reduced pain intensity in patients with calcaneal spurs, with a favorable effect observed for radial extracorporeal shockwave therapy. These methods can be considered effective, safe, and conservative treatment options for managing calcaneal spurs.

Multiple Treatment Strategies of Accessory Renal Artery Related Hypertension: Report of Two Cases and Literature Review.

Renovascular hypertension (RVH) is a primary cause of secondary hypertension, primarily driven by the activation of the renin-angiotensin-aldosterone system activation. Recently, growing studies suggested accessory renal artery (ARA) might also contribute to RVH. However, the treatment of ARA-related hypertension and whether to take interventional treatment lack consensus. Herein, we report two cases of ARA-related hypertension in our hospital. Imaging studies of both patients showed ARA stenosis. One patient had ARA occlusion well-compensated through tortuous collateral branches, achieving normal blood pressure by medical treatment alone. The other patient had ARA stenosis coexisted with main renal artery stenosis, and revascularization of both arteries led to a significant postoperative reduction in blood pressure. A literature review was conducted to summarize overall treatment strategies for ARA-related hypertension and clarify the relationship between ARA and hypertension. Recent research supported an association between ARA and hypertension. While medical therapy remains the first-line treatment for ARA-related hypertension, interventional procedures should be considered for patients whose blood pressure remains uncontrolled despite conservative management.

Neuroepithelial cyst causing homonymous hemianopia treated through surgical marsupialization under visual-evoked potentials: A case report

Background: Neuroepithelial cysts (NECs) are rare entities, occasionally causing neurological symptoms that can be overlooked. Case Description: A case of an occipital neuroepithelial cyst is discussed. The initial presentation consisted of mild homonymous hemianopia and gait impairment. Conservative management was suggested to start with, but at 6 months follow-up, the patient’s symptoms were worsening. Surgery was performed under general anesthetic and using visual-evoked potentials. The cyst was marsupialized and connected with subdural space, and a few samples were sent for histological analysis. The patient experienced immediate improvement in her symptoms, and the visual tests at follow-up confirmed the resolution of the previously documented hemianopia. Conclusion: NECs should be carefully assessed to rule out symptoms associated with mass effects. This case and others reported in the international literature show that occipital neuroepithelial cysts can benefit from surgical treatment with meticulous preoperative planning. The aid of neuromonitoring is crucial to identify anatomical variations and cortical functionality that are potentially distorted in the presence of these lesions.

Comparison of the smiley face rod method versus intervertebral fusion for the treatment of L5 spondylolysis in adults

PurposeFor patients who suffered from L5 spondylolysis and fail to improve using conservative treatment, the best surgical strategy remains controversial. This study compares the efficacy of the treatment of L5 spondylolysis using the smiley face rod (SFR) method versus intervertebral fusion (IF).MethodsWe analyzed 38 patients with L5 spondylolysis who underwent surgery in our department between January 2017 and June 2019. Of these, 32 patients were included in our study: 14 patients in the SFR group and 18 patients in the IF group. The operation time, intraoperative blood loss, postoperative drainage time, length of stay and postoperative complications were compared. The pain visual analog scale (VAS) and Oswestry dysfunction index (ODI) were evaluated before operation and at 3 months, 6 months, and 1 year postoperatively. The changes in range of motion (ROM) in L4/5 and L5/S1 in these two groups before and after surgery were measured through imaging examinations and the bone graft fusion rate was assessed according to the Brown standard.ResultsThe operation time of the SFR group was much shorter than that of the IF group (98.8 ± 8.3 vs. 113.8 ± 8.6 min, P < 0.05), and the blood loss of the SFR group was significantly lower than that of the IF group (90.0 ± 43.9 vs. 175.0 ± 81.2 ml, P < 0.05). Length of stay in the SFR group was less than that of the IF group (9.5 ± 2.5 vs. 12.6 ± 3.2 d, P < 0.05). No difference was found in the VAS and ODI scores between the two groups at 3 months, 6 months, and 1 year after surgery. In the IF group, the ROM in L4/5 showed an obvious increase after surgery compared to that before surgery, and it was much bigger than that of the SFR group (P < 0.05). A notable reduction of ROM was seen in L5/S1 in the IF group compared to the SFR group (P < 0.05). The fusion rate of the isthmus in the SFR group was 79% at 3 months and 86% at 6 months after surgery. In the IF group, one patient suffered from adjacent segment degeneration (ASD), which caused compression symptoms in the lower extremity, and one patient suffered from an internal fixation fracture; these complications were not seen in the SFR group.ConclusionThe SFR and IF both improve the clinical symptoms and quality of life of patients with L5 spondylolysis. However, the SFR technique had the advantages of a shorter operation time and less blood loss than IF; it could also preserve the ROM of the surgical segment and had little influence on adjacent segments in short-term follow-ups.

Conservative therapy for lumbar disc herniation

Herniated discs are acommon cause of neurological symptoms that often lead to reduced quality of life. They affect around 20% of 45-56-year olds and, therefore, represent acorrespondingly major challenge for healthcare. Conservative therapy methods are usually used as the first treatment option; surgical interventions should only be considered in special symptom constellations. This study aims to evaluate the effectiveness of conservative therapy methods in the treatment of lumbar disc herniation and to demonstrate their influence on pain reduction and functional improvement. The current valid AWMF guideline was analyzed, and asystematic literature search was conducted to identify relevant information on the conservative treatment of herniated discs. The therapeutic approaches analyzed included physiotherapy, drug treatment, manual therapy and injection therapies. Inclusion criteria covered reviews and meta-analyses from 2019 to 2024. The analysis showed that conservative treatment methods led to asignificant reduction in pain and improvement in functional abilities in the majority of patients. Not all frequently clinical used forms of therapy have been well proven. The results of this study underline the importance of conservative treatment methods as an effective treatment option for herniated discs. In particular, the combination of different treatment approaches can improve treatment outcomes. However, further long-term studies are needed to determine the long-term effects and optimal treatment protocols.

Sustainable growth, financial flexibility and working capital management in family firms: An empirical study in Indonesia

Family firms play an important role in the economies of developing countries such as Indonesia. Proper working capital management is necessary to support the sustainable growth of family firms. This study aims to analyze the characteristics of sustainable growth and working capital management of family firms. The study analyzes family firms by comparing them with non-family firms listed in the LQ45 index of the Indonesian capital market. Using quantitative methods, logistic regression is used to test the hypotheses. The survey sample covers 280 companies from 2015 to 2022. The results of the study show that the elements of sustainable growth of family firms differ from non-family firms only in the leverage element. Family firms tend to have lower leverage than non-family firms. Family firms tend to have more conservative working capital management policies for investment and financing than non-family firms. Family firms also have longer days of accounts payable outstanding than non-family firms, while days of inventory outstanding and days of sales outstanding are not significantly different. This study suggests that family firms should implement a moderate working capital policy to strengthen sustainable growth rates. AcknowledgementsThe authors would like to thank the Head of Research and Community Service at AKI University who has supported funding for this research. Thank you also to fellow Faculty of Economics and Business lecturers, AKI University who have helped provide the facilities needed for this research.

Menstrual challenges in puberty: Investigating menorrhagia in adolescent girls

Menorrhagia, defined as excessive or prolonged menstrual bleeding, poses a significant challenge during this developmental stage, potentially impacting the health and well-being of adolescent girls. Despite its prevalence, comprehensive studies on menorrhagia in this specific demographic are scarce. This study aims to address this gap by investigating the underlying causes and treatment outcomes of puberty menorrhagia.A six-month observational study involving 50 adolescent girls presenting with menorrhagia was conducted at the Department of Obstetrics and Gynecology in a tertiary care center. The study utilized consecutive enumerative sampling and included a thorough investigation of participants, collecting data on demographic profiles, symptom severity, anemia levels, diagnoses, therapy requirements, and responses to conservative management. Baseline investigations encompassed a range of tests, including pregnancy exclusion, complete blood count, coagulation profile, and hormonal assays.The study cohort of 50 participants revealed varying characteristics: 24% were under 14 years, 34% were between 14-16 years, and 42% were aged 17-19 years. BMI distribution showed 14% below 18.5, 76% between 18.5 and 25, and 10% exceeding 25. Symptom duration included 20% reporting less than 6 months, 34% between 6-12 months, and 46% over 12 months. Etiology analysis indicated 60% with ovulatory dysfunction. Hemoglobin level analysis illustrated the prevalence and severity of anemia. Diverse treatments, including hormonal and non-hormonal interventions, were administered.This study provides insights into the causes of puberty menorrhagia, emphasizing the need for a holistic treatment. Future research should delve deeper into identified associations and clinical variants to enhance our understanding and guide effective interventions. Management should be directed to the cause.

The Management of Symptomatic Moyamoya Disease in Pediatric Patients: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: The optimal management strategy for pediatric patients with symptomatic moyamoya disease (MMD) is not well established. This systematic review and meta-analysis compares surgical vs conservative management and direct/combined bypass (DB/CB) vs indirect bypass (IB) for pediatric patients with symptomatic MMD. METHODS: MEDLINE and PubMed were searched from inception to March 17, 2024. For analysis of surgical vs conservative treatment, the primary and secondary outcomes were follow-up ischemic stroke and intracranial hemorrhagic events, respectively. For analysis of DB/CB vs IB, the primary outcome was follow-up ischemic stroke, and secondary outcomes included follow-up transient ischemic attack, new or worsened seizures, symptomatic improvement, modified Rankin Scale score ≤2, and Matsushima grade A at the last follow-up. RESULTS: Twenty-two included studies yielded 1091 patients, with a median follow-up duration of 35.7 months. Regarding surgical vs conservative management, 428 patients were analyzed. Surgical treatment was associated with lower odds of ischemic stroke (odds ratios [OR] = 0.33 [95% CI, 0.11-0.97], P = .04), and intracranial hemorrhagic events tended to be lower with surgery (OR = 0.25 [0.06-1.03], P = .05). Regarding DB/CB techniques vs IB, 875 patients were analyzed. The groups had similar rates of ischemic stroke (OR = 0.79 [0.31-1.97], P = .61), transient ischemic attack (OR = 1.27[0.46-3.55], P = .64), new or worsened seizures (OR = 1.05[0.3-3.65], P = .93), symptomatic improvement (OR = 2.45[0.71-8.45], P = .16), and follow-up modified Rankin Scale ≤2 (OR = 1.21 [0.16-8.85], P = .85). CB was associated with higher Matsushima grade A relative to IB (OR = 3.44 [1.32-9.97], P = .01). CONCLUSION: Surgical revascularization yielded more favorable clinical outcomes than conservative management in this meta-analysis. Clinical outcomes were similar between DB/CB vs IB techniques. Surgical flow augmentation, either by DB/CB or IB, seems to benefit pediatric patients with symptomatic MMD.

Arthroscopic meniscal posterior root repair combined with centralization reduces medial menicus extrusion associated with posterior root tears: One-year clinical outcomes.

This study aimed to assess the short-term clinical efficacy of combining posterior meniscal root repair with meniscal centralization technology in the treatment of medial meniscus posterior root tears (MMPRTs) and notable meniscus extrusion. In this retrospective analysis, patients aged 43-76 years with only chronic posterior root tears of the medial meniscus and notable extrusion were followed up for 12-14 months. (1) persistent medial knee joint pain affecting daily life, presenting with joint space tenderness; (2) showing the ineffectiveness of conservative treatment for a minimum of 3 months; conservative treatment includes non-invasive methods such as nonsteroidal anti-inflammatory drugs, physical therapy and massage, but does not include intra-articular injections. (3) Kellgren-Lawrence Grades 0-II osteoarthritis (OA) of the knee joint; and (4) diagnosis of a posterior root tear of the medial meniscus with notable meniscus extrusion confirmed through knee-joint plain magnetic resonance imaging (MRI) scans, where coronal image revealed a meniscus body extrusion of ≥3 mm. (1) Kellgren-Lawrence Grades III-IV OA in the knee joint; (2) presence of knee joint infection or other structural damage to the knee joint; (3) history of previous knee joint surgery; (4) demonstrating joint instability or abnormal lower-limb alignment (varus deformity >5°); and (5) presence of severe mental illness, coagulation disorders, or other serious medical conditions. The Lysholms score, the Hospital for Special Surgery (HSS) knee score, the visual analogue scale (VAS) score and meniscal extrusion values were evaluated before and after surgery in 23 patients through a comparative analysis. The results of the follow-up conducted 12-14 months post-operatively indicated a significant improvement in the patients' conditions. In particular, the Lysholms scores (preoperative: 50.9 ± 10.2; 1-year post-surgery: 72.0 ± 8.4), HSS knee scores (preoperative: 45.9 ± 10.6; 1-year post-surgery: 79.1 ± 11.1) and VAS scores (preoperative: 4.0 ± 1.1; 1-year post-surgery: 0.9 ± 0.7) exhibited notable enhancements. Furthermore, compared to the preoperative values, the degree of meniscus extrusion measured by coronal MRI of the knee joint significantly improved post-operatively (preoperative: 3.7 ± 0.8 mm; 1-year post-surgery: 2.2 ± 0.6 mm). These findings all yielded a p < 0.05, signifying statistical significance. In patients with chronic MMPRTs and notable extrusion, a combination of posterior meniscal root repair and centralization technology can effectively restore meniscus function and rectify the medial meniscus displacement, resulting in favourable short-term clinical outcomes. Level IV.

Risk Factors for Postoperative Intra-Abdominal Abscess in Pediatric Perforated Appendicitis Following Laparoscopic Appendectomy: A Multicenter Analysis

Background: Perforated appendicitis in children is a frequently encountered and significant surgical condition. The treatment of choice is laparoscopic appendectomy, but this carries a risk of postoperative intra-abdominal abscess (IAA). The purpose of this study was to determine risk factors linked to the occurrence of IAA following laparoscopic surgery in pediatric perforated appendicitis. Methods: This retrospective cohort study analyzed 137 children with perforated appendicitis who received laparoscopic appendectomy at four tertiary hospitals between March 2018 and December 2022. Data on patient demographics, preoperative clinical characteristics, and surgical details were collected. Independent risk factors for IAA formation were determined using logistic regression analysis. Results: The overall incidence of postoperative IAA was 10.9%. Prolonged symptom duration and elevated CRP levels were associated with higher IAA rates. Patients who developed IAAs experienced prolonged postoperative fevers and longer hospital stays. Significant risk factors for IAA identified through multivariable analysis included a higher severity grade of appendicitis (≥Grade IV, OR 5.9, p = 0.034) and the presence of a free appendicolith during surgery (OR 5.549, p = 0.01). Of the patients who developed IAAs, nine (60%) improved with conservative treatment, while six (40%) required invasive procedures. Conclusions: A higher severity grade of appendicitis (≥Grade IV) and the presence of a free appendicolith are significant predictors of postoperative IAAs in pediatric perforated appendicitis. Recognizing these factors can help guide clinical management and postoperative care, potentially reducing the incidence of this complication.

Repeatable patterns in the distribution of freshwater biodiversity indicators across contrasting landscapes

Abstract Context Freshwater biodiversity is declining at unparalleled rates, but fundamental questions remain over how it is distributed at the spatial scales most relevant for conservation management. Objectives Here, we test the hypothesis that freshwater biodiversity is distributed across standing waterbody types in a pattern that is reproducible across disparate biota and contrasting landscapes, such that conservation efforts can be aligned across landscapes and taxa. Methods We analysed the richness, composition and distribution of macrophytes, molluscs, beetles and odonates from 199 standing waterbodies (lakes, ponds, ditches and canals) nested within UK landscapes with contrasting dominant land use (agricultural, upland and suburban). Results We found a common pattern in the distribution of our biodiversity indicators across waterbody types in all landscapes that was largely repeated across biota; lakes consistently had the highest or equal alpha diversity and supported a greater proportion of the sampled species pool in each landscape (mean = 86%) in comparison to ponds (74%). Landscape-specific waterbody types (ditches and canals) also contributed significantly to the regional species pool (69 and 33% respectively). Each waterbody type contributed uniquely to landscape biodiversity and usually species of conservation concern, rather than simply supporting a subset of ubiquitous species found in lakes. Conclusions Landscape-wide management strategies that encompass multiple habitats and biota should prove advantageous and generalisable. However, our study landscapes suggest that long-term biodiversity conservation should also recognise lakes as a priority for nature recovery, both to minimise further losses and to maintain the largest reservoir of biodiversity.

Djenkolism: Acute Kidney Injury Unresponsive to Conservative Therapy - A Case Report

Djenkol beans (Archidendron jiringa), a popular food in Southeast Asia, can cause djenkolism—a condition leading to acute kidney injury due to the presence of djenkol acid. This case report details a 26-year-old male who presented with three days of anuria following the consumption of half a kilogram of djenkol beans. Upon admission, he exhibited severe abdominal pain, costovertebral tenderness, and elevated renal markers, leading to a diagnosis of obstructive uropathy caused by djenkolic acid crystals. Initial conservative treatment was ineffective, prompting the need for emergency ureteroscopy and placement of bilateral JJ stents to relieve the obstruction. Post-procedure, the patient experienced significant improvement, with a marked increase in urine output; post-obstructive diuresis in the first 24 hours, and resolution of abdominal pain, alongside improved renal function. This case underscores the importance of recognizing djenkolism as a potential cause of acute kidney injury, and advocating for timely diagnosis and intervention to mitigate kidney damage. Public awareness regarding the risks associated with djenkol consumption is also essential. Keywords: Djenkolism, Obstructive Uropathy, Post-Obstructive Diuresis, Acute Kidney Injury

Center of pressure in relation to foot morphology and knee symptoms in older women with medial knee joint deformity: A cross-sectional study.

To examine the correlations amongst center of pressure (COP) trajectories, foot morphology and knee symptoms in older women with medial knee deformity. This was a cross-sectional study. Participants were recruited from two local orthopedic clinics. Eighty-four female patients with medial knee deformity (Kellgren Lawrence grade ≥1) aged 60 years or older. Not applicable. COP trajectories during comfortable gait were obtained using a plantar pressure distribution platform. As foot morphology metrics, hallux valgus angle, navicular/foot ratio, and leg-heel alignment were measured. The knee society scoring system was used to evaluated knee symptom severity. We used statistical parametric mapping for COP trajectory analysis to reduce the bias caused by data extraction. Multiple linear regression in statistical parametric mapping was used to determine the correlations amongst foot morphology, knee symptom severity and COP trajectories. There was a correlation between higher navicular/foot ratio and medial shift on COP at initial contact (0〜3.0% stance phase, p<0.05) and at toe-off (95.3〜100% stance phase, p=0.04). Also, higher navicular/foot ratio was associated with lateral shift of COP during single leg stance phase (8.3〜80.1% stance phase, p<0.01). We also found a significant correlation between lateral shift of COP during loading response phase (6.8〜19.0% stance phase) and knee symptom severity (p=0.03). Our results indicated that patients with severe knee symptoms may benefit from intervention to modify the foot arch and to medially shift the COP, which may be capable of relieving knee symptoms. Although our results do not directly show pain reduction, a medial COP shift could indeed reduce pain in cases where knee adduction moment is responsible for pain. These findings may contribute to the further development of conservative intervention, which focus on knee OA patients' foot morphology.

HPB SO71 - Meta-Anaylsis of Early Endoscopic Retrograde Cholangiopancreatography versus conservative management for gallstone pancreatitis

Abstract Background Acute pancreatitis is one of the most common gastrointestinal causes of hospital admission. The most common cause is transient blockage of the bile or pancreatic duct (or both) by gallstones. Most of the time, pancreatitis responds to conservative management (CM) comprising intravenous fluid hydration and analgesia. ERCP +/_endoscopic sphincterotomy in acute gallstone pancreatitis has been advocated in the past to decrease the number of complications of this condition. However, the role and timing of this procedure are still contentious and an ongoing debate. Method The aim of this study is to compare the clinical outcomes of early urgent ERCP versus conservative management in biliary pancreatitis but not cholangitis. An online search of Medline, Embase, Science citation index, PubMed and Cochrane database of systematic reviews published between 1988 and 2022 was carried out for relevant studies. Statistical analysis was done using Revman 5.4 and Odds ratio with a 95% Confidence interval was used for outcome estimation. There was 14 studies included in the final study consisting a total of 1756 patients with 877 patients in ERCP group while 879 in CM group. Results With random effects model, data showed no significant reduction in mortality in ERCP group as compared to the CM group (OR 0.59, 95% CI 0.30-1.16; p=0.13). However there were overall more local or systemic complications (OR 0.51, 95% CI 0.36-0.71; p&amp;lt;0.002) in the CM group as compared to ERCP group. No statistically significant difference found amongst groups when comparing complications as renal failure(OR-0.99, 95% CI-0.41-2.41, p=0.98), cardiac failure (OR-0.77 95% CI 0.35-1.69, p=0.51) or biliary sepsis (OR-0.56 95%CI 0.15-2.10, p=0.39) but there was more incidence of pseudocyst in CM group patients(OR-0.47, 95% CI 0.25-0.87, p=0.02). Conclusion The above study did show that the mortality rate was not significantly higher in the CM group as compared to the ERCP group however the early ERCP was beneficial in reducing overall complications in the interventional group. Based on this fact, ERCP considered early in the management of acute pancreatitis despite of still being debatable in practice can be considered in severe pancreatitis cases and further high powered randomized controlled trials can be carried out to assess this point.

Comparative Outcomes Between Surgical and Conservative Management of Mallet Thumb: A Systematic Review and Pooled Analysis.

While mallet finger remains a relatively common injury of the hand, mallet thumb is much rarer in occurrence. Mallet thumb management has been noted infrequently within the literature and reliable evidence regarding the most effective method of management remains absent. The aim of this review is to assess the quality of literature that exists pertaining to mallet thumb to determine whether conservative or surgical management is superior. A search was completed in February 2023 of Ovid Medline, Embase, CINAHL, and SPORTDiscus with no limitation on study type, and date of publication. Comparative outcomes of thumb interphalangeal (IP) joint range of motion, tip, lateral pinch and grip strength, complications, outcome measure scores, and follow-up period were recorded. We assessed 103 mallet thumbs (51 surgically and 52 conservatively managed) across the 23 studies of low to moderate quality based on the Structured Effectiveness Quality Evaluation Scale. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. While recommendations remain weak due to low quality of evidence, our review found a lower complication rate and higher IP joint flexion in thumbs managed conservatively. These findings demonstrate a need for future research to shift toward ensuring standardized patient-rated outcome measures are utilized and functional outcomes are included in research planning and operationalization in order to contextualize clinical outcomes.

HPB O05 - Changing paradigms in the management of severe acute pancreatitis: Focused multi-disciplinary working between surgeons and intensivists to mitigate organ failure in order to reduce mortality

Abstract Background Mortality was classically bimodal in severe acute pancreatitis and organ failure is the single most important factor in predicting outcome in severe acute pancreatitis. Initial interventions are supportive often requiring critical care. Subsequently treatments are required to manage necrosis and any organ recovery remains under threat. The outcomes and interventions from surgery and critical care are reviewed to determine how to balance organ failure and the need for necrosectomy in a modern multi-disciplinary tertiary care centre Method The Royal Liverpool provides a tertiary service to all patients with pancreatitis across Merseyside and North Wales. All patients that were transferred to critical care from 2018 – 2023 were analysed using the intensive care national audit and research centre database which contains information on organ failure. The patients with severe pancreatitis were then reviewed using electronic clinical notes and radiology images to determine clinical course and management. Results Of 134 patients, 48 (36%) were admitted locally, 85 (64%) transferred in, occurring 35% &amp;lt;2weeks, 29% 2-4weeks, 28% 4-6weeks and 8% &amp;gt;8weeks. 76 (57%) required necrosis intervention, 58 (43%) were conservatively managed. Mortality was 38% with 35% &amp;lt;4weeks, 22% 4-8weeks, 22% 8-12weeks, 22% &amp;gt;12weeks. No significant difference in mortality between conservative or interventional management (15 (45%) vs 18 (55%)) nor median age (58 vs 57.5 yrs). Survival related to number of failing organs (dead vs alive): nil organs: 10 patients vs 27 patients (20%vs32%), One: 11 vs 45 (22%vs45%), Two: 21 vs 9 (42%vs11%), Three: 8 vs 3 (16%vs4%), p&amp;lt;0.005. Conclusion Of patients deemed fit for ITU admission with necrotising pancreatitis, the classic paradigms of biphasic mortality no longer occur. Differences in mortality from intervention and age of patient has been negated by optimal ITU management for organ failure. For the initial phases and the intervention phases of management, ensuring degree of organ failure is key to survival. There is a significant change when two organs fail in mortality and this stresses the importance of holistic management. Our ITU promotes pancreas specific organ preservation measures of early enteral feeding, cessation/tailoring of antibiotics, early extubation/tracheostomy and most importantly multidisciplinary working