Short-term Recovery Research Articles

The effect of annulus fibrosus incision and foraminoplasty on lumbar biomechanics in percutaneous endoscopic lumbar discectomy: a finite element analysis

The objective of this study was to analyze the effects of annulus fibrosus incision and foraminoplasty on lumbar biomechanics during posterior lateral approach translaminar percutaneous endoscopic lumbar discectomy (PELD) using a lumbar 4/5 segment model and three-dimensional finite element analysis (FEA). We created a model of the L4 to L5 segment and performed simulated foraminoplasty, annulus fibrosus incision, and a combined operation. The models were tested under six working conditions, and we recorded the deformation and equivalent strain/stress of each group. Results showed that foraminoplasty can affect the stability and rotation axis of the segment during rotation without significantly impacting discal stress. Conversely, annulus fibrosus incision significantly increases discal stress except for when the patient is doing a forward flexion movement. We recommend that surgical maneuvers minimize the removal and destruction of the annulus fibrosus and that rotation movements are avoided during the short-term recovery period following PELD surgery.

Short-Term Recovery of Pilot Living Shoreline Projects for Salt Marsh Habitat in New Hampshire

Short-Term Recovery of Pilot Living Shoreline Projects for Salt Marsh Habitat in New Hampshire

Research on motion control of the semi-submersible platform under the mooring line failure

The mooring line failure can cause significant drift, continuous mooring line failures, riser collision and production shutdown, but mooring line repairs and replacements are time consuming, and there is a lack of associated short-term emergency measures. To solve the above problems, a short-term recovery strategy is proposed in this paper to suppress low-frequency motions. The strategy contains a control process consisting of five controllers and a thrust distribution optimization algorithm and a prediction process consisting of the LSTM and Dense neural network. The simulation results show that all five controllers can suppress the low-frequency motion after mooring line failure, and the control efficiency of the controller can be improved and the control force and power consumption can be reduced with the help of the predictive correction algorithm. The combination of the predictor-corrector algorithm and the model-free adaptive controller provides the best comprehensive performance. The direction of the control force and the average propulsion angle of the thrusters are independent of the wave direction and are related to the direction of the failed mooring line.

Functional near-infrared spectroscopy approach to the emotional regulation effect of drawing: Venting versus distraction.

Drawing can regulate emotions through venting or distraction. Distraction is more helpful for short-term emotion recovery; however, the sustainability of this difference is yet to be clarified. This study used functional near-infrared spectroscopy (fNIRS) to explore potential differences between venting and distraction. A total of 44 college students participated in the experiment. After inducing fear by video, they were divided into two groups: The venting group drew their emotional experience, and the distraction group drew a house. Subsequently, the participants were instructed to relax by a brief video. Although the distraction group had a higher valence than the venting group at the end of the drawing activity, there was no difference between the two groups after a relaxation period. Additionally, the activation pattern of the prefrontal cortex differed between the two groups. Compared to the distraction group, the venting group had fewer channels with elevated prefrontal activity during drawing, suggesting less cognitive control, and had more channels with reduced prefrontal activity during relaxation, suggesting a higher level of relaxation. Drawing coding and fNIRS data were both associated with variations in valence. The less the cognitive control over emotion and the more free the expression of emotion during drawing, the higher the increase in valence; inversely, the more the cognitive control over emotion and the less free the expression of emotion, the lower the increase in valence.

Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Pilot Randomized Controlled Trial.

Acute lateral ankle sprains are common injuries among athletes, but the optimal treatment strategies in elite athletes are still debated. This proof-of-concept study aimed to assess the impact of cryo-ultrasound therapy on the short-term recovery of football players with acute lateral ankle sprains. Semi-professional football players with grade I or II lateral ankle sprains were randomly assigned to the experimental group (receiving cryo-ultrasound therapy combined with conventional physical therapy) or control group (sham cryo-ultrasound therapy combined with conventional physical therapy). Pain intensity and physical functioning were assessed by the Numeric Rating Scale (NRS) and Foot and Ankle Disability Index (FADI) at baseline (T0) at the end of treatment (T1), after one month (T2), and two months after treatment (T3). After the study intervention, significant between groups differences were reported in terms of pain relief (NRS: 4.08 ± 1.29 vs. 5.87 ± 1.19; p = 0.003) and physical function (FADI: 50.9 ± 10.3 vs. 38.3 ± 11.5; p = 0.021). However, no significant between group differences were reported at T2 and T3. No adverse effects were reported. Cryo-ultrasound therapy combined with conventional physical therapy can accelerate recovery and early return to sport in elite football players with acute lateral ankle sprains. While this study contributes valuable insights into the potential benefits of cryo-ultrasound therapy, further investigations with a longer follow-up are needed to validate and optimize the application of physical agent modalities in the management of ankle injuries.

Clinical, magnetic resonance imaging, surgical features and comparison of surgically treated intervertebral disc extrusion in French bulldogs.

Intervertebral disc (IVD) extrusion (IVDE) is the most reported neurological condition in French bulldogs (FBD). The aim of this study was to retrospectively evaluate neurological grade, magnetic resonance imaging (MRI), surgical findings and short-term recovery in surgically treated FBD diagnosed with IVDE referred to a single institution between January 2020 and March 2022 and to compare cervical and thoracolumbar IVDE. Data was gathered from medical records and analysed via Fischer's Exact-Test and Kruskal Wallis-tests. Statistical significance was assumed when p < 0.05. Thirty-nine FBD were diagnosed with IVDE. Cervical IVDE (C-IVDE) was diagnosed in 11/39 cases; the C3-C4 IVD space was the most commonly affected site (5/11). Thoracolumbar IVDE (TL-IVDE) was diagnosed in 28 cases; the L3-L4 IVD space was the most commonly affected site (7/28). At admission, C-IVDE was significantly associated with less severe neurological grade (grade 1-2) compared to TL-IVDE (grade 2-5) (p < 0.001). The extruded IVD material (EIVDM) was hypointense in T2w images in 11/11C-IVDE vs. 2/28TL-IVDE, and hypointense in T1w images in 10/11C-IVDE vs. 1/28TL-IVDE. The EIVDM was hyperintense in T2w images in 0/11C-IVDE vs. 26/28TL-IVDE and iso-to-hypointense in T1w images in 1/11C-IVDE vs. 27/28TL-IVDE (p < 0,001). The EIVDM extended over ≥2 IVD spaces in 0/11C-IVDE vs. 19/28TL-IVDE (p < 0,001). 10/11C-IVDE underwent single ventral slot, 1/11C-IVDE underwent unilateral cervical hemilaminectomy. All TL-IVDE underwent unilateral hemilaminectomy and 19/28TL-IVDE underwent unilateral hemilaminectomy over ≥2 IVD spaces (p < 0,001). Haemorrhagic EIVDM was noticed intraoperatively in 1/11C-IVDE vs. 28/28TL-IVDE (p < 0,001). Spinal cord compression was mild in 2/11C-IVDE and 3/28TL-IVDE; moderate in 9/11C-IVDE and 16/28TL-IVDE; severe in 0/11C-IVDE and 8/28TL-IVDE. There was no spinal cord compression in 1/28TL-IVDE with foraminal IVDE. There was no statistical difference between spinal cord compression and IVDE location (p = 0.112). The mean time to improvement was 1.1 day in C-IVDE (range 1-2 days). 90.1% of C-IVDE improved within the first 24 h. The mean time to improvement was 2.1 days in TL-IVDE (range from 1 day to 4 days). All dogs that did not improve (5/39) were grade 5 TL-IVDEs at presentation. In FBD, TL-IVDE tended to cause higher grade of neurological dysfunction, tended to result in compression of neural structures over multiple IVD spaces and required more extensive surgical treatment than C-IVDE.

An Evaluation of a Pesticide Training Program to Reduce Pesticide Exposure and Enhance Safety among Female Farmworkers in Nan, Thailand.

Although exposure to chemical pesticides is known to cause negative effects on human health, farmers in Ban Luang, Nan, Thailand, continue to use them regularly to protect crops. This study focused on mothers who were engaged in farm tasks and had children between the ages of 0 to 72 months, with the objective of reducing pesticide exposure. This study was conducted from May 2020 to October 2020 in the Ban Fa and Ban Phi sub-districts in Ban Luang due to the high use of pesticides in these areas. A systematic random sampling technique was used to recruit 78 mothers exposed to pesticides. Thirty-nine mothers from Ban Fa district were randomly assigned to the intervention group and 39 from Ban Phi to the control group over a 3-month period. This study applied a pesticide behavioral change training program for the intervention group. To assess the effectiveness of the program, the study compared the results of a questionnaire regarding knowledge, attitude, and practice (KAP) and health beliefs related to pesticide exposure as well as the levels of acetylcholinesterase (AChE) and butyryl cholinesterase (BChE) enzymes, biomarkers of exposure to pesticides, before and after the intervention using ANCOVA statistical test. Furthermore, to evaluate the effectiveness of the intervention program, a paired t-test was used to investigate the in-home pesticide safety assessment. After the intervention, we observed no significant change in AChE; however, a significant improvement in BChE (p < 0.05), a marker of short-term recovery, was observed. Pesticides can cause a reduction in AChE and BChE, however, after eliminating pesticides, BChE takes a shorter time (about 30-50 days) to recover than AChE (around 90-120 days). Therefore, increases in the measured concentrations of AChE and/or BChE suggest the presence of less chemicals from pesticides in the human body. The study also found a significant improvement in KAP and beliefs about chemical pesticide exposure after the intervention (p < 0.05). Furthermore, using a paired t-test, we found a significant increase in pesticide safety practices (p < 0.05) in the intervention group and a borderline significant increase regarding in-home safety (p = 0.051) in the control group. Based on the results, the constructs of the intervention program were effective and could be applied in other agricultural areas in less developed countries. However, due to time limitations during the COVID-19 pandemic, further studies should be conducted to enable data collection over a longer time, with a larger number of subjects providing the ChE levels for the non-agricultural season.

Disaster reconnaissance framework for sustainable post-disaster materials management

A first foundational assessment is provided for disaster debris reconnaissance that includes identifying tools and techniques for reconnaissance activities, identifying challenges in field reconnaissance, and identifying and developing preliminary guidelines and standards based on advancements from a workshop held in 2022. In this workshop, reconnaissance activities were analyzed in twofold: in relation to post-disaster debris and waste materials and in relation to waste management infrastructure. A four-phase timeline was included to capture the full lifecycle of management activities ranging from collection to temporary storage to final management route: pre-disaster or pre-reconnaissance, post-disaster response (days/weeks), short-term recovery (weeks/months), and long-term recovery (months/years). For successful reconnaissance, objectives of field activities and data collection needs; data types and metrics; and measurement and determination methods need to be identified. A reconnaissance framework, represented using a 3x2x2x4 matrix, is proposed to incorporate data attributes (tools, challenges, guides), reconnaissance attributes (debris, infrastructure; factors, actions), and time attributes (pre-event, response, short-term, long-term). This framework supports field reconnaissance missions and protocols that are longitudinally based and focused on post-disaster waste material and infrastructure metrics that advance sustainable materials management practices. To properly frame and develop effective reconnaissance activities, actions for all data attributes (tools, challenges, guides) are proposed to integrate sustainability and resilience considerations. While existing metrics, tools, methods, standards, and protocols can be adapted for sustainable post-disaster materials management reconnaissance, development of new approaches are needed for addressing unique aspects of disaster debris management.

Iron Status and Short-Term Recovery after Non-Severe Acute Myocarditis: A Prospective Observational Study.

Pathomechanisms responsible for recovery from acute myocarditis (MCD) or progression to non-ischemic cardiomyopathy have not been comprehensively investigated. Iron, positioned at the crossroads of inflammation and the energy metabolism of cardiomyocytes, may contribute to the pathophysiology of inflammatory myocardial disease. The aim of this study was to evaluate whether systemic iron parameters are related to myocardial dysfunction in MCD patients. We prospectively enrolled 42 consecutive patients hospitalized for MCD. Their iron status and their clinical, laboratory, and echocardiographic indices were assessed during hospitalization and during ambulatory visits six weeks after discharge. A control group comprising healthy volunteers was recruited. The MCD patients had higher serum ferritin and hepcidin and lower serum iron concentration and transferrin saturation (TSAT) than the healthy controls (all p < 0.01). Six weeks after discharge, the iron status of the MCD patients was already comparable to that of the control group. During hospitalization, lower serum iron and TSAT correlated with higher NT-proBNP (both p < 0.05). In-hospital lower serum iron and TSAT correlated with both a lower left ventricular ejection fraction (LVEF) and worse left ventricular global longitudinal strain at follow-up visits (all p < 0.05). In conclusion, in patients with acute MCD, iron status is altered and normalizes within six weeks. Low serum iron and TSAT are related to greater in-hospital neurohormonal activation and subtle persistent left ventricular dysfunction.

A two-stage stochastic post-disaster humanitarian supply chain network design problem

We consider the planning problem of designing and operating humanitarian supply chain networks (HSCN) after natural disasters. Specifically, we focus on the design of a three-layer network under demand and capacity uncertainty to support short-term recovery, i.e., to distribute critical supplies to the affected population. We aim to analyze the effect of unmet demand accumulating over the planning horizon in order to better understand and respond to natural disasters. To this end, we explicitly consider the impact of unmet demand through time under uncertain conditions by introducing a spread factor. We develop a two-stage stochastic model that retains the uncertainty pertaining to the demand along with the transportation and storage capacities of the HSCN. Then, we apply our model to a case study using real-world data from the 2018 earthquake in Indonesia. Various aspects of the problem are studied over a set of experiments, including the importance of modeling uncertainty, the effect of the budget on the solution performance, and the role of the spread factor in the accurate understanding of the crisis. According to the results obtained, considering lower values for the spread factor parameter can irreparably misguide the decision-makers by an inaccurate presentation of the crisis’ depth and consequently increase the damage caused to people’s health

Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis.

We compared the short-term recovery of patients treated with trapeziometacarpal joint (TMJ) implant arthroplasty versus resection-suspension-interposition (RSI) arthroplasty. Implant patients (n = 147) had a better 3-month postoperative brief Michigan Hand Outcomes Questionnaire (MHQ) score (mean 82) compared to RSI patients (n = 127), who had a mean score of 69. Key pinch strength at 3 months was also higher in the implant group compared to the RSI group (6.8 kg vs. 3.1 kg). At 1 year, both groups had similar brief MHQ scores, but key pinch remained higher in the implant group (7.0 kg vs. 3.9 kg [RSI]). After implant arthroplasty, employed patients returned to work after a mean of 44 days, which was significantly faster than the 84 days for RSI patients. Patients after TMJ implant arthroplasty recover significantly faster in the first 3 postoperative months compared to RSI patients. However, 1-year postoperative outcomes are similar for both cohorts, with key pinch strength remaining higher for patients with TMJ implant arthroplasty.Level of evidence: II.

Do All Types of Restorative Environments in the Urban Park Provide the Same Level of Benefits for Young Adults? A Field Experiment in Nanjing, China

Previous research has consistently shown that exposure to natural environments provides a variety of health benefits. The purpose of this study is to investigate the restorative benefits of non-virtual environments in field experiments as well as the differences in physiological and psychological effects between different types of restorative sites for stressed young adults. This controlled study design used the Positive and Negative Affect Schedule (PANAS), electroencephalogram (EEG), and heart rate variability (HRV) as psychophysiological indicators of individual affect and stress. We used a “stress imposition-greenspace recovery” pre- and post-test mode to simulate the most realistic short-term recovery experience in the park (Grassplots, Square, Forest, and Lakeside) under relatively free conditions. The experimental results show that all four natural spaces in the park have some degree of recovery. However, there were discernible differences in the restorative effects of four selected natural sites. Lakeside and Forest demonstrated the most robust restorative properties in terms of both negative emotion reduction and positive emotion enhancement. In contrast, Square showed the weakest facilitation of recovery, while Grassplots promoted moderate resilience. Physiologically, we found that the EEG-α% of the Square was significantly lower than the EEG-α% of the Forest (t = −3.56, p = 0.015). This means that stressed young adults were much more relaxed in the forest than in the paved square. The study answers which types of natural spaces, when considered together, would provide greater restorative benefits to stressed young people participating in natural therapies in urban parks. The study’s policy implications include the need to create more green natural spaces, especially forests with multiple plant levels, as well as to improve the restorative nature of urban parks through appropriate landscape space design.

Extended Superolateral Cheek Lift With a Short Preauricular Scar: A Local Anesthesia-based Practicable Technique for the Correction of Moderate-degree Facial Aging Signs.

An ideal technique applicable to middle-aged individuals with a moderate degree of facial aging signs has not yet been established. This study aimed to evaluate the utility of an extended superolateral cheek lift with a short preauricular scar technique for the correction of facial aging signs. A total of 200 female patients (mean age: 43y, range 27-56y) who underwent a local anesthesia-based extended superolateral cheek lift for the correction of facial aging signs confined to the malar and nasolabial area, lower eyelid, jawline, and neck were included. Data on the Global Aesthetic Improvement Scale, patient-reported outcomes, and complications were recorded at 1, 6, 12, and 24 months postoperatively. The Global Aesthetic Improvement Scale scores revealed exceptional improvement in 90% of patients along with no complications at month 24. None of the patients developed a depressed scar, skin necrosis, breaking of the superficial musculoaponeurotic system plication sutures, asymmetry, or facial nerve problems. At postoperative month 24, the appearance was reported to be very much improved by 90% of patients, and 94% of patients reported that they were very satisfied with the treatment and that they would recommend this treatment to friends and acquaintances. Our findings revealed the potential utility of an extended superolateral cheek lift with a short preauricular scar as a local anesthesia-based practicable technique for the correction of facial aging signs in middle-aged patients, offering a favorable postoperative outcome, lack of complications and high patient satisfaction in addition to invisible scars and a short-term postoperative recovery.

Diffuse Axonal Injury Pattern Predicts Timing of In-Hospital Neurologic Recovery: A Retrospective Case Series

Diffuse axonal injury (DAI) is a devastating traumatic neurological injury with variable prognosis. Although outcomes such as mortality have been described, the time course of neurological progression is poorly understood. We investigated the association between DAI neuroanatomical injury pattern and neurological recovery timing. A retrospective review of our institution's trauma registry identified patients diagnosed with DAI from 2017-2021. Neuroradiologist review of head CT was used to score DAI severity. In-hospital neurological exams were reviewed, and GCS was calculated for all patients throughout the hospital stay. Categorical variables were analyzed using Fisher's exact test and continuous variables were analyzed using Kruskal-Wallis test. Nineteen DAI patients (Grade 1=8; Grade 2=1; Grade 3=10) were included (mean age 31 years, 79% male). Mean Rotterdam CT score, Injury Severity Scale, and admission GCS were comparable across DAI grades. Mean time in days to follow commands was shorter for those with Grade 1 DAI (9.3) compared to Grade 2 (17 days) or Grade 3 (19 days) DAI (p=0.02). Throughout hospitalization, patients with Grade 1 DAI had higher motor (p=0.006), eye (p=0.001), and total GCS (p=0.011) score compared to those with Grade 2 or 3 DAI. At the time of discharge, total GCS and the frequency of command following was similar across DAI grades. Patients with Grade 1 DAI demonstrated the fastest short-term neurological recovery, although final discharge neurological examination was comparable across DAI grades. DAI classification can provide useful short-term prognostic information regarding in-hospital neurological improvement.

Divergent responses of ecosystem services to afforestation and grassland restoration in the Tibetan Plateau

Afforestation and grassland restoration have been proposed as important pathways for nature-based solutions. However, the effects of different ecological restoration projects on multiple ecosystem services are poorly understood, inhibiting our ability to maximize ecosystem services for further restoration. Here, we provide a comprehensive assessment of the impact of different ecological projects on ecosystem services (carbon storage, water conservation, soil retention), using a pairwise comparative study of samples from 90 project–control pairs in the Tibetan Plateau. Our results found that afforestation increased carbon storage (31.3%) and soil retention (37.6%), but the effects of grassland restoration on services were mixed, while the overall changes in water conservation were negligible. Prior land use/measures and the age of project implementation were key factors in regulating ecosystem service responses. For example, afforestation on bare land increased carbon storage and soil retention but indirectly decreased water conservation by influencing vegetation cover, while cropland afforestation increased water and soil retention. Ecosystem services increased with project age after afforestation. For grassland restoration, short-term recovery increased carbon storage but was not effective in improving water and soil retention. Climate and topography also directly or indirectly controlled the response of ecosystem services by affecting the changes in total nitrogen, total porosity, clay and fractional vegetation cover following the projects. This study improves our current understanding of the mechanisms underlying the responses of ecosystem services to afforestation and grassland restoration. Our results suggest that sustainable restoration management taking into account prior land use/measures, implementation age, climate, topography and other resources is critical for optimizing ecosystem services.

1551-P: Association between Short-Term Postprandial C-Peptide Index Recovery during Hospitalization and Future Glycemic Control in Patients with Type 2 Diabetes

Endogenous insulin secretion could be recovered by improving hyperglycemia in patients with type 2 diabetes (T2D). However, no reports have showed the associations between short-term insulin secretion recovery and future glycemic control. In this study, we investigated whether short-term C-peptide index (CPI) recovery during hospitalization could predict future glycemic control. In this study, 117 patients with T2D were included. The recovery of fasting and postprandial CPI were defined as (fasting CPI at discharge - fasting CPI at admission [index-A]) and (postprandial CPI at discharge - postprandial CPI at admission [index-B]). We compared the clinical background between the low-recovery and high-recovery groups of each index and assessed the association between the indices and metabolic parameters after discharge. Using index-A, age was significantly younger (P = 0.017) and body mass index (BMI) was significantly higher (P = 0.004) in the high-recovery group than that in low-recovery group. Using index-B, the age was significantly younger (P = 0.019) and BMI was significantly higher (P = 0.004) in the high-recovery group. Additionally, visceral fat area (P = 0.043), serum TG (P &amp;lt; 0.001), and γ-GTP levels (P = 0.009) were significantly higher in the high-recovery group. Regarding the association between CPI recovery and future glycemic control, GA levels were significantly lower in the high-recovery group than that in low-recovery group at 6 months (16.7 vs 21.1%, P = 0.045) and 12 months (16.8 vs 21.7%, P = 0.033) after discharge in the analysis using index-B. Furthermore, postprandial CPI (cut-off; 3.79 [AUC 0.698, P = 0.007]) at discharge and index-B (cut-off; 1.66 [AUC 0.657, P = 0.018]) were identified as indicators to predict HbA1c ≤ 7.0% at 6 months after discharge. In conclusion, short-term postprandial CPI recovery during hospitalization may predict future glycemic control. Disclosure A.Enkaku: None. D.Chujo: None. M.Kamigishi: None. S.Inagawa: None. W.Sakai: None. S.Matsukoshi: None. A.Takikawa: None. S.Fujisaka: None. K.Tobe: Other Relationship; MSD K.K., Novo Nordisk Pharma Ltd., Takeda Pharmaceutical Company Limited, Daiichi Sankyo, Mitsubishi Tanabe Pharma Corporation, Suntory Global Corporation, Ltd.,, Taiho Pharmaceutical Co. Ltd., Japan Diabetes Foundation, Japan Association for Diabetes Education and Care.

Association of Open Reduction and Internal Fixation With Volar Locking Plate for Distal Radius Fractures With Patient-Reported Outcomes in Older Adults

ImportanceRandomized clinical trials (RCTs) and meta-analyses have reported inconsistent conclusions regarding optimal distal radius fracture (DRF) treatment in older adults and are limited due to the inclusion of cohort studies with small sample sizes. A network meta-analysis (NMA) addresses these limitations by only synthesizing direct and indirect evidence from RCTs and may clarify optimal DRF treatment in older adults.ObjectiveTo examine DRF treatment results in optimal short-term and intermediate-term patient-reported outcomes.Data SourcesSearches of MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials were conducted for RCTs that investigated DRF treatment outcomes in older adults between January 1, 2000, and January 1, 2022.Study SelectionRandomized clinical trials including patients with a mean age of 50 years or older that compared the following DRF treatments were eligible for inclusion: casting, open reduction and internal fixation with volar lock plating (ORIF), external fixation, percutaneous pinning, and nail fixation.Data Extraction and SynthesisTwo reviewers independently completed all data extraction. An NMA aggregated all direct and indirect evidence among DRF treatments. Treatments were ranked by surface under the cumulative ranking curve score. Data are reported as standard mean differences (SMDs) and 95% CIs.Main Outcomes and MeasuresThe primary outcome was short-term (≤3 months) and intermediate-term (&amp;amp;gt;3 months to 1 year) Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. Secondary outcomes included Patient-Rated Wrist Evaluation (PRWE) scores and 1-year complication rates.ResultsIn this NMA, 23 RCTs consisting of 3054 participants (2495 women [81.7%]) with a mean (SD) age of 66 (7.8) years were included. At 3 months, DASH scores were significantly lower for nail fixation (SMD, −18.28; 95% CI, −29.93 to −6.63) and ORIF (SMD, −9.28; 95% CI, −13.90 to −4.66) compared with casting. The PRWE scores were also significantly lower for ORIF (SMD, −9.55; 95% CI, −15.31 to −3.79) at 3 months. In the intermediate term, ORIF was associated with lowered DASH (SMD, −3.35; 95% CI, −5.90 to −0.80) and PRWE (SMD, −2.90; 95% CI, −4.86 to −0.94) scores. One-year complication rates were comparable among all treatments.Conclusions and RelevanceThe findings of this NMA suggest that ORIF may be associated with clinically significant improvements in short-term recovery compared with casting for multiple patient-reported outcomes measures with no increase in 1-year complication rates. Shared decision-making with patients may be useful to identify patient preferences regarding recovery to determine optimal treatment.

Short- and long-term outcomes of laparoscopic or robotic radical gastrectomy based on preoperative perigastric artery CTA surgical decision-making: a high-volume center retrospective study with propensity score matching.

Some studies have demonstrated the short-term recovery course for patients who underwent laparoscopic gastrectomy according to preoperative computed tomography angiography (CTA) assessment. However, reports of the long-term oncological outcomes are still limited. The data of 988 consecutive patients who underwent laparoscopic or robotic radical gastrectomy between January 2014 and September 2018 were analyzed retrospectively at our center, and propensity score matching was used to eliminate bias. Study cohorts were divided into the CTA group (n = 498) and the non-CTA group (n = 490) depending on whether preoperative CTA was available. The primary and secondary endpoints were the 3-year overall survival (OS) and disease-free survival (DFS) rates and the intraoperative course and short-term outcomes, respectively. 431 patients were included in each group after PSM. Compared with the non-CTA group, the CTA group had more harvested lymph nodes and less operative time, blood loss, intraoperative vascular injury and total cost, especially in the subgroup analysis with BMI ≥ 25kg/m2 patients. There was no difference in the 3 year OS and DFS between the CTA group and the non-CTA group. When further stratified by BMI < 25 or ≥ 25kg/m2, the 3-year OS and DFS were significantly higher in the CTA group than in the non-CTA group in terms of BMI ≥ 25kg/m2. Laparoscopic or robotic radical gastrectomy based on preoperative perigastric artery CTA surgical decision-making has the possibility of improving short-term outcomes. However, there is no difference in the long-term prognosis, except for a subgroup of patients with BMI ≥ 25kg/m2.

Motor unit firing rates in young and very old adult males during an isokinetic fatiguing task and short-term recovery in the anconeus muscle.

Understanding motor unit (MU) properties with muscle fatigue in adult aging is limited to isometric tasks. The purpose was to investigate the effect of an isokinetic fatiguing task on MU firing rates between two adult age groups of males. Single MUs were recorded by intramuscular electrodes in the anconeus muscle of eight young (19-33 yr) and 11 very old adults (78-93 yr). Fatigue was induced by repeated isokinetic maximal voluntary contractions at 25% of maximum velocity (Vmax), until elbow extension power decreased by 35%. At baseline, the very old had lower maximal power (135 vs. 214 W, P = 0.002) and slower maximal velocity (177 vs. 196°/s, P < 0.001) compared with young. Despite a similar number of contractions (average 39 young and 44 very old) to task failure (P = 0.33), the older males were less fatigable as time under tension was ∼25% longer (P = 0.04). Maximum firing rates from ∼20 single MUs per age group were tracked continuously throughout the task and during 10 min of recovery. Similar rates were recorded (24.7 and 23.6 Hz, P = 0.18) at baseline 25% Vmax, and during the task (23.3 and 28.7% decrease, P = 0.21) between young and very old, respectively. Power and MU rates were recovered similarly by 2 min of rest in both groups (all P > 0.15). Despite differences in baseline capability, very old males in this relatively slow isokinetic task were more fatigue resistant, but the fatigue-related reduction and recovery in MU rates were similar between groups. Therefore, fatigue in this task between age groups is not differentially affected by alterations in firing rates.NEW & NOTEWORTHY Maximal motor unit firing rates were recorded during an isokinetic fatiguing protocol and short-term recovery in young and very old adult males. Prior studies were limited to isometric fatiguing tasks. Despite the old being ∼37% weaker and less fatigable, anconeus rates during elbow extension declined with fatigue and recovered similarly to young males. Therefore, it is unlikely that greater fatigue resistance of very old males during isokinetic contractions is related to differences in motor unit rates.

#5627 SYSTEMATIC HISTOLOGICAL SCORING OF TUBULOINTERSTITIAL LESIONS CORRELATE WITH CLINICAL PARAMETERS IN ANCA-ASSOCIATED GLOMERULONEPHRITIS

Abstract Background and Aims Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a small vessel vasculitis affecting multiple organ systems, including the kidney. Small vessels in the kidney include small-sized arteries (interlobular artery, afferent and efferent arteriole), capillaries (glomerular and peritubular capillary) and venules. Although crescentic ANCA glomerulonephritis (GN) is a common histological finding reflecting glomerular small vessel vasculitis, it is reasonable that manifestation of AAV could also contribute to interstitial small vessel vasculitis. Therefore, we here aimed to expand our current knowledge focusing on interstitial vasculitis in ANCA GN by systematic histological scoring of vascular lesions analogous to Banff. Method A total number of 49 kidney biopsies with confirmed renal involvement of AAV at the University Medical Center Göttingen were retrospectively included between 2015 till 2020. A renal pathologist evaluated all biopsies and was blinded to clinical data collection and analysis. A detailed methological section is provided in the Supplementary material and methods section. Results Since previous studies established that crescentic ANCA GN associates with severe kidney injury and acute deterioration of kidney function in AAV, we first systematically scored interstitial vasculitis in association with requirement of renal replacement therapy (RRT). Among all active and chronic tubulointerstitial lesions analogous to the Banff scoring system, the only association between severe kidney injury requiring RRT was observed for interstitial vasculitis in AAV reflected by peritubular capillaritis (ptc, p = 0.0002) and arteritis (v, p = 0.0069), affecting 5/49 (10.2%) and 11/49 (22.4%) of renal biopsies, respectively. Since it is known that severe deterioration of kidney function also correlates with crescentic ANCA GN, we next directly compared glomerular and tubulointerstitial lesions. The fraction of normal glomeruli was inversely associated with interstitial fibrosis (ci), total (ti) and inflammation in IFTA (i-IFTA), whereas glomerular crescents were associated with interstitial inflammation (i), tubulitis (t) and total inflammation (ti). In contrast, global glomerular sclerosis associated with less interstitial inflammation (i) but correlated with interstitial fibrosis (ci) and tubular atrophy (ct), confirming established mechansim that chronic glomerular injury leads to tubular atrophy and interstitial fibrosis. Interestingly, no association between interstitial vasculitis (ptc and v correlating with severe kidney injury) and any glomerular lesion in ANCA GN (also correlating with severe kidney injury) was observed, thereby confirming that interstitial vasculitis contributes to severe kidney injury independent of ANCA GN. By contrast, short-term renal recovery from RRT was equal in both groups, suggesting a distinct association with acute decline of kidney function at disease onset. Conclusion Taken together, by using the Banff scoring system we here expand our current knowledge of renal interstitial lesions in AAV revealing peritubular capillaritis and arteritis as important histological alterations associated with severe kidney injury in a considerable subset of AAV. Furthermore, our findings that interstitial vasculitis did not correlate with crescentic ANCA GN implicate that the characteristics of each vasculitis manifestation are independent and could further improve our understanding of mechanisms contributing to renal injury. These observations suggest that interstitial vasculitis in AAV may also affect long-term prognosis requiring further investigation.