Factor In Recovery Research Articles

Lumbar Disc Herniation—the Significance of Symptom Duration for the Indication for Surgery.

Lumbar disc surgery is among the more common spinal procedures. In this paper, we report the current treatment recommendations for patients with symptomatic disc herniation. This review is based on pertinent publications retrieved by a selective literature search in PubMed using the terms [timing] AND [lumbar disc herniation], supplemented by other relevant articles and guidelines. Symptoms resolve in 60% to 80% of patients with herniated discs in 6-12 weeks, and in 80% to 90% over the long term (≥ 1 year). According to the guidelines, 6-12 weeks of conservative treatment are recommended in the absence of significant neu - rologic deficits. Early surgery is indicated in case of worsening pain or new onset of neurologic deficits. Lumbar disc herniation associated bladder or bowel dysfunction (cauda equina syndrome) is considered an absolute surgical emergency that requires immediate decompression (within 24 to 48 hours). Patients with severe motor deficits (MRC ≤ 3/5) benefit from early intervention and should be offered surgery within three days, if possible, for the best chance of recovery. The degree of weakness and the duration of symptoms have been identified as risk factors for incomplete recovery. Early surgery can be considered in patients with mild paresis (MRC 4/5) in case of functional impairment (e.g., quadriceps paresis). Longer symptom duration and lower motor scores are associated with worse outcome and a lower chance of neurologic recovery. The recovery rate for motor deficits ranges from 33% to 75%, depending on the timing and modality of treatment as well as the motor score.

Topsoil dilution by subsoil admixture had less impact on soil organic carbon stock development than fertilizer form and erosion state

Enhancing the agroecosystems carbon (C) sink function for climate mitigation faced challenges, particularly with traditional measures with limited suitability for increasing soil organic carbon (SOC) stocks. Inducing a SOC undersaturation in the topsoil by abrupt subsoil admixture is a way to create an additional C sink. However, the deep tillage traditionally used for this topsoil dilution was not always successful. It was due to a lack of knowledge and suitable approaches to record the effect of all relevant factors in SOC recovery, including soil conditions and fertilizer forms.We addressed these problems by establishing a three-factorial experiment: I) “moderate topsoil dilution,” II) “N fertilization form,” and III) “soil erosion state,” representing three soil types in the hummocky ground moraine landscape of NE Germany. SOC dynamics were determined over a year of winter rye cropping using a novel robotic chamber system capable of measuring CO2 exchange on 36 experimental plots with a reduced methodological bias than previous measuring systems.The averaged net ecosystem carbon balance, a proxy for SOC stock change, indicated that topsoil dilution only reduced further SOC losses. The N fertilizer form had a significantly stronger and more differentiated effect. While the mineral N fertilization consistently produced only C sources, the organic fertilization, in combination with the diluted topsoil, led to a C sink. This C-sink function was, however, more pronounced in the eroded soil than in the non-eroded soil. Overall, the results have made clear that the impact of topsoil dilution on the further development of the SOC stock is only possible if the effect of other relevant factors, such as N fertilizer form and erosion state, are taken into account.

Comparison of efficacy of intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine in terms of enhanced recovery after surgery (ERAS) for ACL reconstructions

: Bupivacaine is the drug of choice in spinal anaesthesia (SA), while Ropivacaine with its comparatively shorter duration of motor block allows early mobilization post ACL reconstruction surgery which is a crucial factor in Early Recovery after Surgery. : In this randomized double-blind comparative study of a total of 60 patients irrespective of gender undergoing ACL reconstruction surgery were studied. After Administration of SA to group R (2.5ml of 0.75% Heavy Ropivacaine) & group B (2.5ml of 0.5% Bupivacaine) both were compared for their post-operative effects with Bromage score, Aldrete score & Visual Analogue Score. : The time required for complete regression of motor blockade in group R (144.5+26.1 mins) < group B (181±21.3mins) which allowed for early mobilization which over all provides better and faster recovery.: Hyperbaric Ropivacaine when compared to Bupivacaine promises better results in terms of early ambulation and intraoperative hemodynamic stability promoting ERAS in patients undergoing ACL reconstruction surgeries. Promoting ERAS policy will reduce the duration of hospital stay, thereby improving the cost-effectiveness of health services.

Effect of repeated sciatic nerve crush on the conditioning lesion response: Generating an experimental animal model to prolong the denervation period while maintaining peripheral nerve continuity

Peripheral nerves exhibit long-term residual motor dysfunction following injury. The length of the denervation period before nerve and muscle reconnection is an important factor in motor function recovery. We aimed to investigate whether repeated nerve crush injuries to the same site every 7 days would preserve the conditioning lesion (CL) response and to determine the number of nerve crush injuries required to create an experimental animal model that would prolong the denervation period while maintaining peripheral nerve continuity. Rats were grouped according to the number of sciatic nerve crushes. A significant decrease in the soleus muscle fiber cross-sectional area was observed with increased crushes. After a single crush, macrophage accumulation and macrophage chemotaxis factor CCL2 expression in dorsal root ganglia were markedly increased, which aligned with the gene expression of Ccl2 and its receptor Ccr2. Macrophage numbers, histological CCL2 expression, and Ccl2 and Ccr2 gene expression levels decreased, depending on the number of repeated crushes. Histological analysis and gene expression analysis in the group with four repeated crushes did not differ significantly when compared with uninjured animals. Our findings indicated that repeated nerve crushes at the same site every 7 days sustained innervation loss and caused a loss of the CL response. The experimental model did not require nerve stump suturing and is useful for exploring factors causing prolonged denervation-induced motor dysfunction. Significance StatementThis study elucidates the effects of repeated nerve crush injury to the same site on innervation and conditioning lesion responses and demonstrates the utility of an experimental animal model that recapitulates the persistent residual motor deficits owing to prolonged denervation without requiring nerve transection and transection suturing.

Sustainable recovery and recycling of acidic ionic liquid in 5-ethoxymethylfurfural production via bipolar membrane electrodialysis

Acidic ionic liquids have been proven effective as homogeneous catalysts in preparing 5-ethoxymethylfurfural the fuel additive and platform chemical. Homogeneous catalysis specialty and complicated electrolyte composition limited direct recovery of acidic ionic liquids after 5-ethoxymethylfurfural preparation. In this study, a bipolar membrane electrodialysis (BMED)-based strategy was designed for controllably recovering and regenerating acidic ionic liquid 1-butyl-3-methylimidazolium hydrogen sulfate [Bmim][HSO4] after 5-ethoxymethylfurfural preparation from fructose. Key factors in recovery of ionic liquid [Bmim][HSO4] were studied to ascertain the technical and financial feasibility of the electrodialysis-assisted strategy. The maximum recovery ratio of [Bmim][HSO4] approached 96.2% and the minimum recovery cost was less than 0.1% of [Bmim][HSO4] purchase cost. Insight developed by the work revealed a viable solution for efficient and integral recycling of acidic imidazole ionic liquid in the high-value conversion of biomass.

Predictors of time to recovery from uncomplicated severe acute malnutrition among children in eastern Ethiopia.

Managing severe acute malnutrition (SAM) involves an outpatient therapeutic program (OTP), targeting more than 80% of SAM children where the quality of primary healthcare remains poor. Treatment success and recovery from SAM remain poor and could be affected by many factors, where such evidence is limited in East Hararghe. This study assessed the predictors of time to recovery from SAM in eastern Ethiopia. A retrospective cohort study was conducted on 402 records of SAM children under 5 years of age enrolled on OTP at 12 health posts retrieved from 2020 to 2021. We used the Kaplan-Meir estimate along with the p-value of the log-rank test and the survival curve to compare the time to recovery across categories. A multivariable Cox proportional hazard model was fitted to identify predictors of time to recovery from SAM. A p-value below 0.05 was used to declare statistical significance. A total of 402 records were reviewed, and the cure rate from SAM was 89.6% [95% confidence interval (CI), 87-93]. Moreover, a death rate of 0.7%, a default rate of 9.5%, and a non-responder rate of 0.2% were obtained with a median length of stay of 7 weeks. The median time to recovery was significantly shorter for children from shorter distances from OTP sites with edema, amoxicillin, (p < 0.05). Edema at admission [adjusted hazard ratio (AHR) = 1.74; 95% CI: 1.33-2.29], without diarrhea (AHR = 1.51; 95% CI: 1.18-1.94), taking amoxicillin (AHR = 1.55; 95% CI: 1.19-2.02), shorter travel time to the OTP site (AHR = 1.44; 95% CI: 1.13-1.85), breastfeeding (AHR = 1.60; 95% CI: 1.27-2.02), adequacy of ready-to-use therapeutic food (RUTF) (AHR = 1.22; 95% CI: 0.90-1.65), and new admission (AHR = 1.62; 95% CI: 0.84-3.10) were important predictors of recovery from SAM. Recovery from SAM was found to be acceptable in comparison with the Sphere Standards and is predicted by edema, diarrhea, distance from the OTP site, amoxicillin, and RUTF adequacy. These allow for focused interventions that address the identified factors for better recovery from SAM.

Treatment outcomes and prognostic factors of bowel function recovery after hyperthermic intraperitoneal chemotherapy and cytoreductive surgery for metastatic cancers of the abdomen and pelvis.

e23225 Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is combined with cytoreductive surgery (CRS) to treat metastatic tumors of the abdomen and pelvis. The risk factors of GI dysmotility after HIPEC and CRS are not well known. Methods: We performed a single-center, retrospective chart review including all patients who had undergone HIPEC and CRS for metastatic cancer of the abdomen and pelvis from 2016-2023 to assess the prognostic factors of bowel function after HIPEC and CRS treatment. Patients were classified into high or low peritoneal cancer burden by a peritoneal cancer index (PCI) score. Statistics: Categorical variables were summarized by count and percentage and continuous variables. Comparisons of categorical and continuous covariables were conducted using Fisher’s exact test and the Wilcoxon rank sum test. Results: 195 patients met the study criteria. Duration of bowel recovery time in the High PCI was significantly higher than in the Low PCI group (median 11.5 days vs 9 days, p = 0.027). Persistent bowel dysfunction at day 30 was (7.47 x) associated with malnutrition (p = 0.001) and (6.95 x) a venting G Tube (p = 0.032) and history of radiation (p = 0.019) and Pre-OP Opioid Use (p = 0.01). Metoclopramide, Erythromycin and Mu Antagonists were used in 32%, 4.7% and 1.2% respectively of patients with bowel dysfunction. Conclusions: Patients with a high PCI score had a statistically significant longer duration of bowel dysfunction. Malnutrition and a history of radiation were statistically higher in patients with prolonged bowel dysfunction. Use of prokinetics and mu receptor antagonists was uncommon. [Table: see text]

Focal motor weakness and recovery following chronic subdural hematoma evacuation.

The incidence of chronic subdural hematomas (cSDHs) is expected to climb precipitously in the coming decades because of the aging populous. Neurological weakness is one of the most common presenting neurological symptoms of cSDH. Yet, the recovery rates of motor strength recovery are seldom documented, as neurological outcomes have predominantly focused on broader functional assessment scores or mortality. In this study, the authors performed one of the first detailed analyses on functional motor weakness and recovery in patients who underwent cSDH evacuation. Patients who underwent evacuation of a cSDH at a tertiary academic medical center between November 2013 and December 2021 were retrospectively identified using ICD-9 and ICD-10 billing codes. The presence of focal motor weakness was subcategorized by location as upper extremity (UE) or lower extremity (LE). Postoperative improvement, worsening, or resolution of weakness was recorded at the time of discharge. Statistical analysis included univariate and backward stepwise multivariable logistic regression modeling. A total of 311 patients were included in the analysis. Patients were significantly more likely to experience UE weakness than LE weakness (29% vs 18%, p < 0.001). Forty-one percent (43/104) had both UE and LE weakness present. Risk factors for the development of focal motor weakness at the time of presentation were older age (OR 1.02, p = 0.03), increased cSDH size (OR 1.04, p = 0.02), and the presence of a unilateral cSDH (OR 2.32, p = 0.008). The majority of patients (68%, 71/104) experienced motor strength improvement following cSDH evacuation, with 58% (60/104) having complete resolution of weakness. Multivariable logistic regression analysis revealed that longer symptom duration was associated with lower rates of improvement (OR 0.96, p = 0.024). Older age was also associated with reduced resolution of weakness (OR 0.96, p = 0.02). This study represents one of the first in-depth analyses investigating the rates of motor strength weakness and recovery following cSDH evacuation. Nearly two-thirds of all patients had complete resolution of their weakness by the time of discharge, and more than three-quarters had partial improvement. Risk factors for impaired neurological recovery were longer symptom duration prior to treatment and older age.

Lung function and symptom recovery in chronic obstructive pulmonary disease with pneumonic and non-pneumonic exacerbations

RATIONALE Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) accelerate decline in lung function and are associated with hospitalization. Patients with COPD are at risk for community acquired pneumonia (CAP). There may be a benefit to distinguish between these entities. OBJECTIVES The objectives of this research were to assess differences in initial presentation and short-term lung function and symptom recovery in patients with COPD hospitalized for AECOPD or CAP. METHODS A single center, non-interventional, prospective cohort study of patients with COPD hospitalized with AECOPD or CAP was used. Baseline characteristics were collected. Spirometry was obtained on admission, at discharge, and 6-wk post-discharge. The primary outcome was change in forced expiratory volume in the first second (FEV1%) predicted over time. COPD Assessment Test (CAT) was used to assess symptom burden on admission and 6-wk post-discharge. MAIN RESULTS A total of 54 patients were recruited, all with at least moderate airflow obstruction. On admission, there were higher levels of CRP in COPD with CAP compared to AECOPD (86.4 [SD 81.9] vs 33.5 [35.4]). There was a statistically significant difference in FEV1% predicted (p = 0.0038) and CAT score (p = 0.0005) over time, after adjusting for presence of CAP. However, there was no difference in FEV1% predicted (p = 0.7184) or CAT score (p = 0.441), between those with an AECOPD and COPD with CAP, after adjusting for time. Average length of stay in hospital was longer in COPD with CAP than for AECOPD (11.0 [10.2] versus 6.9 [4.5] days). CONCLUSIONS Time is the principal factor in short term lung function and symptom recovery in patients with COPD hospitalized for acute respiratory decompensation.

The independence of impairments in proprioception and visuomotor adaptation after stroke

BackgroundProprioceptive impairments are common after stroke and are associated with worse motor recovery and poor rehabilitation outcomes. Motor learning may also be an important factor in motor recovery, and some evidence in healthy adults suggests that reduced proprioceptive function is associated with reductions in motor learning. It is unclear how impairments in proprioception and motor learning relate after stroke. Here we used robotics and a traditional clinical assessment to examine the link between impairments in proprioception after stroke and a type of motor learning known as visuomotor adaptation.MethodsWe recruited participants with first-time unilateral stroke and controls matched for overall age and sex. Proprioceptive impairments in the more affected arm were assessed using robotic arm position- (APM) and movement-matching (AMM) tasks. We also assessed proprioceptive impairments using a clinical scale (Thumb Localization Test; TLT). Visuomotor adaptation was assessed using a task that systematically rotated hand cursor feedback during reaching movements (VMR). We quantified how much participants adapted to the disturbance and how many trials they took to adapt to the same levels as controls. Spearman’s rho was used to examine the relationship between proprioception, assessed using robotics and the TLT, and visuomotor adaptation. Data from healthy adults were used to identify participants with stroke who were impaired in proprioception and visuomotor adaptation. The independence of impairments in proprioception and adaptation were examined using Fisher’s exact tests.ResultsImpairments in proprioception (58.3%) and adaptation (52.1%) were common in participants with stroke (n = 48; 2.10% acute, 70.8% subacute, 27.1% chronic stroke). Performance on the APM task, AMM task, and TLT scores correlated weakly with measures of visuomotor adaptation. Fisher’s exact tests demonstrated that impairments in proprioception, assessed using robotics and the TLT, were independent from impairments in visuomotor adaptation in our sample.ConclusionOur results suggest impairments in proprioception may be independent from impairments in visuomotor adaptation after stroke. Further studies are needed to understand factors that influence the relationship between motor learning, proprioception and other rehabilitation outcomes throughout stroke recovery.

The Role of Pre-existing Anti-HLA Antibodies in Severe Aplastic Anemia Patients Undergoing Allogenic Hematopoietic Stem Cell Transplantation

The objective is to underscore the significance of pre-existing anti-HLA Abs in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for SAA. A retrospective analysis was conducted using data from 244 SAA patients who underwent allo-HSCT between January 2016 and October 2022. The patient cohort was divided into 2 groups based on the presence of pre-existing anti-HLA Abs. Out of 244 SAA patients, 82 were tested positive for anti-HLA Abs. Seventeen patients were tested with DSA in haplo-HSCT. We found that the presence of pre-existing anti-HLA Abs did not influence neutrophil engraftment (P = .600); however, it resulted in delayed platelet recovery (P = .006). Comparatively, patients with anti-HLA Abs demonstrated lower overall survival (OS) compared to their counter parts without anti-HLA Abs (P = .001), with a correspondingly elevated transplant-related mortality (TRM) in the former group (P = .002). Multivariate analysis established pre-existing anti-HLA Abs as an independent risk factor for impaired platelet recovery (HR 1.67, 95% CI 1.16 to 2.44, P = .006) and OS (HR 2.19, 95% CI 1.03 to 4.67, P = .043). However, there were no differences between DSA and non-DSA patients after desensitization in haplo-HSCT. In summary, the presence of pre-existing anti-HLA Abs in SAA patients undergoing allo-HSCT appears to detrimentally affect platelet recovery and overall prognosis.

TSoSRA: A task-oriented resilience assessment framework for system-of-systems

System-of-systems (SoS) are inevitably subject to disturbances during task execution, and resilience is a key factor for SoS damage and recovery. System-of-systems resilience (SoSR) assessment holds significant value in optimizing SoS architecture and completing tasks. However, identifying the most resilient SoS among different ones for the same task is a basic but challenging question. This paper proposes a task-oriented SoSR assessment framework (TSoSRA) to identify the most resilient SoS. First, we use a heterogeneous information network and meta-path to describe a SoS network architecture composed of different subsystems and the SoS performance model is developed, based on node and link quality. Based on this model, a system-of-system resilience metric (SoSRM) is proposed to describe the ability of the SoS to recover quickly dealing with disruption. Then, we extend further this metric to consider the impact of mitigation measures that exist in practical scenarios. Finally, we demonstrate the feasibility and effectiveness of TSoSRA through a case study, offering valuable insights to enhance network security, improve SoS reliability and design a more resilient SoS.

Recovery After Sport-Related Concussion in Collegiate Athletes With Self-Reported Pre-Injury Migraines.

Pre-injury migraines might be a risk factor for prolonged recovery after sport-related concussion (SRC). We sought to examine whether a pre-injury history of migraines is associated with worse recovery following SRC in collegiate athletes. Data were collected through a prospective concussion surveillance system in 11 National Collegiate Athletic Association (NCAA) Division III college athletic programs between September 2014 and March 2020. Our primary independent variable, pre-injury migraines, were self-reported by the athletes. Between those with and without migraines, the outcomes of days to return-to-learn (RTL) without academic accommodations and return-to-play (RTP) were compared using Mann-Whitney U tests. Each athlete's RTL and RTP status was dichotomized (i.e., returned vs. not returned) at various time points for RTL (i.e., 7/14/21/28 days) and RTP (i.e., 14/21/28/56 days). Chi-squared tests were performed to compare the proportions of RTL and RTP status between groups. Multivariable regressions analyzed potential predictors of RTL and RTP adjusting for age, gender, prior concussions, other health conditions, and symptom severity. Of 1409 athletes with an SRC, 111 (7.9%) had a pre-injury history of migraines. Compared with those without migraines, those with migraines had longer median (interquartile range [IQR]) days to RTL (migraines = 7.0 [3.0-12.3] vs. no migraines = 5.0 [2.0-10.0], U = 53,590.5, p = 0.022). No differences were found in RTP between the two groups (migraines = 16.0 [10.0-33.0] vs. nχo migraines 15.0 [11.0-23.0], U = 38,545.0, p = 0.408). Regarding RTL, significantly lower proportions of athletes in the migraine group had fully RTL, without accommodations, at ≤14 days (77.5% vs. 85.2%, χ2 = 4.33, p = 0.037), ≤21 days (85.3% vs. 93.0%, χ2 = 7.99, p = 0.005), and ≤28 days (88.2% vs. 95.6%, χ2 = 10.60, p = 0.001). Regarding RTP, a significantly lower proportion of athletes in the migraine group RTP at ≤28 days (72.0% vs. 82.7%, χ2 = 5.40, p = 0.020) and ≤56 days (84.0% vs. 93.0%, χ2 = 8.19, p = 0.004). In a multivariable model predicting RTL that was adjusted for age, gender, acute concussion symptoms, and other health variables (e.g., attention-deficit/hyperactivity disorder [ADHD], history of mental health difficulties), pre-injury history of migraine was associated with longer RTL (β = 0.06, p = 0.030). In a multivariable model predicting RTP, pre-injury history of migraine was not associated with RTP (β = 0.04, p = 0.192). In collegiate athletes, pre-injury migraine history was independently associated with longer RTL but not RTP. When comparing the proportions of those with successful RTP by days, significantly lower proportions of those with migraines showed successful RTP at ≤28 days and ≤56 days. Futures studies should study the generalizability of our findings in other school levels.

Predictive Factors of Oral Intake Recovery of Acute Illness Patients

Predictive Factors of Oral Intake Recovery of Acute Illness Patients

"Caminando Con Riesgo": perceptions of occupational injury, workplace safety and workers rights among Spanish-speaking hospitalized patients.

Occupational health disparities are well documented among immigrant populations and occupational injury remains a high cause of morbidity and mortality among immigrant populations. There are several factors that contribute to the high prevalence of work-related injury among this population and those without legal status are more likely to experience abusive labor practices that can lead to injury. While the work-related injuries and experiences of Spanish-speaking workers have been explored previously, there is a paucity of literature documenting injury among hospitalized patients. Additionally, there are few documented hospital-based occupational injury prevention programs and no programs that implement workers rights information. The purpose of this study was to further explore the context of work related injuries primarily experienced by Spanish speaking patients and knowledge of their rights in the workplace. This was a semi-structured qualitative interview study with Spanish speaking patients admitted to the hospital for work related injuries. The study team member conducting interviews was bilingual and trained in qualitative methodology. An interview guide was utilized for all interviews and was developed with an immigrant workers rights organization and study team expertise, and factors documented in the literature. Participants were asked about the type and context of the injury sustained, access and perceptions of workplace safety, and knowledge of participants rights as workers. All interviews were conducted in Spanish, recorded, transcribed in Spanish and then translated into English. A codebook was developed and refined iteratively and two independent coders coded all English transcripts using Dedoose. Interviews were conducted until thematic saturation was reached and data was analyzed using a thematic analysis approach. A total of eight interviews were completed. All participants reported working in hazardous conditions that resulted in an injury. Participants expressed a relative acceptance that their workplace environment was dangerous and acknowledged that injuries were common, essentially normalizing the risk of injury. There were varying reports of access to and utilization of safety information and equipment and employer engagement in safety was perceived as a facilitator to safety. Most participants did have some familiarity with Occupational Safety and Health Administration (OSHA) inspections but were not as familiar with OSHA procedures and their rights as workers. We identified several themes related to workplace injury among Spanish speaking patients, many of which raise concerns about access to workplace safety, re-injury and long-term recovery. The context around immigration is particularly important to consider and may lead to unique risk factors for injury, recovery, and re-injury both in the workplace and beyond the workplace, suggesting that perhaps immigration status alone may serve as a predisposition to injury. Thus, it is critical to understand the context around work related injuries in this population considering the tremendous impact of employment on one's health and financial stability. Further research on this topic is warranted, specifically the exploration of multiple intersecting layers of exposure to injury among immigrant populations. Future work should focus on hospital-based strategies for injury prevention and know your rights education tailored to Spanish speaking populations.

Could a low-dose definitive radiation therapy be the optimal treatment for choroidal hemangioma?

PurposeTo determine the efficacy of low-dose intensity-modulated radiation therapy (IMRT)/volumetric intensity-modulated arc therapy (VMAT) in the treatment of symptomatic choroidal hemangioma (CH). Materials and methodsFifty-three consecutive patients with CH were retrospectively reviewed. All the patients underwent IMRT/VMAT as a unique treatment. Resolution of subretinal fluid (SRF), improvement of best-corrected visual acuity (BCVA), and reduction in tumor thickness were compared before and after radiotherapy. ResultsAfter definitive radiotherapy, 100 % of SRF and 76.7 % of exudative retinal detachment were resolved. 56.6 % of BCVA improvement in more than two lines was observed. The mean best-corrected visual acuity was 20/280 (range, 20/1200–20/40) at diagnosis and 20/100 (range, 20/1200–20/20) after treatment. The mean tumor thickness decreased significantly from 3.8 mm initially to 1.2 mm after treatment (p < 0.01). 66.0 % of patients were delivered with 21.6 Gy (range, 21.6–42 Gy), 84.9 % of fractional dose was 1.8 Gy (range, 1.8–2 Gy). No radiation-induced keratitis, retinopathy, or optic neuropathy were observed. Initial vision (p = 0.042), duration time of vision (p = 0.004), and tumor thickness (p = 0.049) were prognostic factors for vision recovery. ConclusionLow-dose IMRT/VMAT could effectively induce involution of the CH, with reduction of subretinal fluid and relief of damage to the neurosensory retina, which is an effective treatment mode for CH.

Resilience of Aboveground Biomass of Secondary Forests Following the Abandonment of Gold Mining Activity in the Southeastern Peruvian Amazon

Amazon rainforests are critical for providing a wide range of ecosystem services. In the Southeastern Peruvian Amazon; however, goldmining activities are causing severe soil degradation and forest loss. We analyzed aboveground biomass (AGB), forest structure, and species diversity recovery during secondary succession in 179 forest plots. Our study provides the first field-based quantification of AGB recovery following the abandonment by two types of goldmining (heavy machinery and suction pumping) in Madre de Dios (Peru). We found that successional secondary forests in areas subjected to suction pumping were more resilient than those in areas subjected to heavy machinery. After 20 years, mean AGB in suction pumping mining areas had reached 56% of reference forest AGB, while in areas of heavy machinery mining it was only 18%. Mining type, stand age, and distance from the forest edge had a significant effect on AGB. The influence of the distance from the forest edge on AGB varies according to mining type because the effects of species diversity on AGB are mediated by the distance from the forest edge. Our results clearly showed the dynamics of AGB recovery across a secondary succession after goldmining, and the contrasting responses of AGB between the two mining types. Our study disentangles the importance of key factors in forest recovery after mining and improves understanding of the resilience of biomass accumulation in these highly degraded ecosystems.

Association between the initial physical activity and functional recovery after 1 month of inpatient rehabilitation for subacute stroke: stratified analysis by nutritional status.

Objectively measured physical activity volume serves as a predictive factor for functional recovery in patients with stroke. Malnutrition, a frequent complication of stroke, may influence the relationship between physical activity and functional recovery. This study aimed to examine the association between physical activity volume and functional recovery in patients with stroke, stratified by their nutritional status. This multicenter prospective observational study included 209 patients with stroke admitted to two Japanese convalescent rehabilitation hospitals. Participants were categorized based on the geriatric nutritional risk index (GNRI) at admission [≥92, high GNRI group ( n = 133); <92, low GNRI group ( n = 76)]. Physical activity levels were measured as the duration of total physical activity (TPA), which is the sum of light-intensity physical activity and moderate-to-vigorous physical activity, using a triaxial accelerometer during the first 7 days after admission. Outcome measures are represented as the relative gain of the motor score on functional independence measure (M-FIM effectiveness) during the first month after admission. The multiple regression analysis, adjusting for age, sex, comorbidity, onset to admission intervals, motor paralysis, initial M-FIM, and cognitive FIM, showed that the duration of TPA in the first 7 days was significantly associated with the M-FIM effectiveness over the first month in both low GNRI [ B = 0.12, 95% confidential intervals (CI) = 0.01; 0.24, P = 0.049] and high GNRI group ( B = 0.11, 95% CI = 0.01; 0.21, P = 0.027). This study demonstrates a positive predictive association between early TPA level and functional recovery in stroke patients, irrespective of their nutritional status.

The Effect of 12 Weeks of Rebound Therapy Exercise Training on Walking Ability of Spinal Cord Injury Patients.

Walking ability is a crucial factor for recovery and rehabilitation of spinal cord injury (SCI) patients. The aim of this study was to investigate the effect of 12 weeks of rebound therapy on walking parameters in SCI patients. Thirty members of Isfahan Spinal Cord Injury Association participated in this experimental study using a convenience sampling method. This study was approved by the ethics committee of the University of Isfahan (IR.UI.REC.1400.118). The participants were randomly assigned to control and rebound groups using a matched randomization method. Data were collected before and after 12 weeks of rebound therapy exercise (three sessions per week) in the walking laboratory, using a seven-camera 3D motion capturing system (Qualisys motion analysis). The final data were analyzed using repeated measures ANOVA in SPSS software (significance level p < .05). Rebound therapy training significantly improved all dependent variables (p < .05) except hip rotation, indicating its effectiveness for enhancing walking ability. Given the importance of walking function, we recommend the use of rebound therapy training as an exercise rehabilitation method for spinal cord injury patients.

Predictors of nutritional recovery time in children aged 6-59months with severe acute malnutrition in Sofala Province, Mozambique: survival analysis approach.

Malnutrition is a public health problem that affects physical and psychosocial well-being. It manifests as a rapid deterioration in nutritional status and bilateral edema due to inadequate food intake or illness. This study is a retrospective cohort of 1208 children with severe acute malnutrition (SAM) in Sofala Province from 2018 to 2022. It includes hospitalized children aged 6-59months with SAM and related complications. The dependent variable is recovery, and the independent variables include age, sex of the child, vomiting, dehydration, hypoglycemia, nutritional edema and anthropometry. Survival curves were plotted using the Kaplan-Meier method, and bivariable and multivariable Cox regression analyses were performed. The crude analysis revealed significant factors for nutritional recovery in children with SAM, including age, weight, height, malaria, diarrhea and dehydration. Children under 24months had a 28% lower likelihood of recovery. Weight below 6.16kg decreased the likelihood by 2%, and height above 71.1cm decreased it by 20%. Conversely, malaria, diarrhea and dehydration increased the likelihood of recovery. However, after adjustment, only diarrhea remained a significant predictor of nutritional recovery. This study found that diarrhea is a predictor of nutritional recovery in children with SAM.