Upper-limb Research Articles

Predisposing factors for incomplete spontaneous recovery after Parsonage-Turner Syndrome.

Parsonage-Turner Syndrome (PTS) is a rare idiopathic brachial neuritis that classically presents with sudden onset upper extremity pain followed by upper limb weakness, sensory disruption, and muscle atrophy. We hypothesized that the type of antecedent event before symptom onset would determine the degree of spontaneous recovery after PTS. We retrospectively reviewed all patients who presented with PTS to a single tertiary referral center from January 2002 to December 2021. Each medical record was reviewed to exclude patients with any other identifiable neurologic etiology. The primary outcome was improved muscle strength measured by a modified British Medical Research Council (mBMRC) grading system. The spontaneous recovery cohort included patients with appreciable or full recovery (mBMRC 4 and 5). In contrast, patients with little to no recovery (mBMRC 0 to 3) were included in the incomplete recovery group. Antecedent events, demographic variables, affected upper extremity region, time between symptom onset and final visit, and presence of nerve surgery were analyzed. Two-tailed T-test and Fisher exact tests were used to compare continuous and categorical variables. Multivariable logistic regression was modeled to identify variables associated with spontaneous recovery. 100 patients with 144 extremities met the inclusion criteria. The average time from symptom onset to the final clinic visit was 3.5 years. 65 extremities (57.0%) spontaneously recovered without surgical intervention, whereas 49 extremities (43.0%) incompletely recovered. The spontaneous recovery cohort was younger (mean [SD] age, 47.4 [18.1] vs. 56.5 [18.7]; p = 0.02) and had fewer bilateral cases (count[%], 4 [6.5%] vs. 10 [26.3%]; p = 0.008). Multivariable logistic regression revealed that each year of increased age was associated with a 3% decreased chance of spontaneous recovery (OR[95%CI] 0.97[0.95, 0.99], p = 0.046). Bilateral involvement was associated with 93% decreased chance of recovery (OR[95%CI] 0.07[0.01, 0.39], p = 0.002), each additional muscle affected was associated with 10% decreased chance of recovery (OR[95%CI] 0.90[0.83, 0.97], p = 0.01), and traumatic antecedent events were associated with increased chance of recovery (OR[95%CI] 27.3[2.59, 287.5], p = 0.006). Younger patients with unilateral symptoms and fewer muscle involvement have a greater chance of spontaneous recovery after PTS. PTS precipitated by trauma may have better spontaneous recovery than those precipitated by other causes.

Abstract 4136884: Incidence and Characteristics of Peri-Procedural Complications of Cardiac Implantable Electrical Devices in Breast Cancer Survivors

Introduction: Breast cancer (BC) is the most common non-cutaneous cancer in women. Several BC treatments increase the risk of conduction abnormalities and heart failure, potentially requiring cardiac implantable electrical devices (CIEDs). Due to vascular access devices, surgical management, and chest wall radiation, these patients are subject to upper extremity vascular alterations. There is limited data regarding CIED use in this population. Research question: Do patients with BC and CIEDs have different procedural approaches or complications compared to the general population? Aims: This study aimed to evaluate CIED placement and periprocedural complications in patients with a history of BC. Methods: This was a retrospective study of CIEDs placed at our institution between 2005 and 2023. Patients with a diagnosis of BC prior to time of placement were included. Complications included those within 30 days of the procedure. Results: We analyzed 109 female patients (median age of 73 years, IQR 66-80) who received pacemaker (PPM, 58.7%), cardiac resynchronization therapy defibrillator (CRT-D, 22%), implantable cardioverter defibrillator (ICD, 16.5%), or cardiac resynchronization therapy pacemaker (CRT-P, 2.8%). The median time from cancer diagnosis to device placement was 13 years (IQR 7-21). Oncologic therapies are included in Figure 1. In patients with unilateral cancer, most devices (78.4%) were placed contralaterally, with 32% of all devices being right sided. Anatomy related to chemotherapy port altered intraoperative approach in 2 cases and bilateral lymph node dissection necessitated subcutaneous ICD in 1 case. Complications were noted in 12 patients (11%) and included hematoma, lead revision, upper extremity DVT, pericardial effusion, stress cardiomyopathy, perforation, site infection, and worsening of chronic lymphedema. Conclusions: BC survivors undergoing CIED placement appear to be at higher risk of periprocedural complications when compared to the general population. They are more likely to undergo right sided device placement to avoid vascular access ipsilateral to prior surgery or radiation. Further studies are required to understand the long-term outcomes of CIED placement in this cohort of patients.

Long-Term Physiological Adaptations Induced by Short-Interval High-Intensity Exercises: An RCT Comparing Active and Passive Recovery

Background: High-intensity interval training (HIIT) is one of the most debated methods involving several parameters that could be modulated, but the long-term adaptations it induces are still unclear. This investigation aimed to evaluate the efficacy of running and whole-body exercises with high-intensity (>80% heart rate) short intervals (30 s) in body composition and physical performance and compare the effects between groups with active (AR) or passive recovery (PR), both in males and females. Methods: Eighteen trained young adults (55.56% ♀) were randomly allocated to the PR (n = 9, 23.09 ± 2.56 years, 163.69 ± 9.88 cm, 68.96 ± 14.62 kg) or AR (n = 9, 22.05 ± 1.54 years, 170.61 ± 11.5 cm, 68.78 ± 12.45 kg) group. Both groups performed eight weeks of HIIT, with an equal progression, training, and volume load (TL: F = 1.55, p = 0.214; VL: F = 0.81, p = 0.505). Body fat (BF), fat-free mass (FFM), upper and lower limb fat (UFI, LFI) and muscle areas (UMA, LMA), handgrip strength (HGS), power (countermovement jump, CMJ), agility (5-0-5), and maximal oxygen consumption (V˙O2p) were tested before and after treatments. Results: The proposed HIIT reduced BF by 9.57% and increased FFM by 2.09%. Females reported better adaptations in LMA (8.34 times higher than males), while both sexes’ upper limb mass distribution was better affected by PR (♀: UFI g = 1.851, 95% CI: 0.51, 3.14; ♂: UFI g = 2.456, 95% CI: 0.336, 4.487). Concerning conditioning, the protocol increased V˙O2p by 6.47%. Females showed better adaptations in CMJ (RR = 1.8), while males showed better adaptations in agility (RR = 3.76). The interaction effects were significant for PR females (right = +6.28%; left = +9.28%) and for AR males (right = +19.21%; left = +19.04%) in HGS. Conclusions: Short-interval HIIT with different exercise recovery types may be a practical solution in training where several physiological improvements are needed. Coaches and trainers can take advantage of the versatile nature of HIIT, relying on desired movement patterns and long-term responses in both male and female individuals.

BiCap: A novel bi-modal dataset of daily living dual-arm manipulation actions

Dual-arm manipulation of daily living objects is essential for robots operating in household environments. Learning from demonstration is a promising approach for teaching robots dual-arm manipulation skills. It usually requires a dataset of participants demonstrating the sequence of manipulation actions to achieve a goal. That sequence can be represented using symbolical or trajectory encoding. The symbolic-encoded sequence is known as the task plan. The chief limitations of current datasets are that most tend to disregard dual-arm manipulation skills and omit the formal grammar used to annotate the task plans. This paper introduces BiCap, a novel bi-modal dataset of dual-arm manipulation actions on daily living objects coupled with a bio-inspired action context-free grammar for fine-grained task plan annotation to train, test, and validate learning from demonstration-based algorithms for robotic dual-arm manipulation. 15 participants were recruited. The experimenter placed reflective markers on their upper limbs and pelvis. Then, the participants sat at a table where one or two objects were placed. They performed one of the following tasks: pouring, opening, and passing, using both hands. An RGB camera pointing towards the table recorded the participants’ hand movements. Subsequently, an annotator reviewed the RGB videos and wrote the participants’ task plans using the bio-inspired action context-free grammar. The participants’ upper-limb kinematics were computed, too, which provides the trajectory-encoded action sequences. The resulting dataset, BiCap, contains 4,026 task plans, videos, and motion data of the 15 participants.

Predicting sarcopenia in community-dwelling older adults through comprehensive physical fitness tests.

Sarcopenia is typically assessed through hand grip strength, walking speed, and chair stand tests. However, it has been inadequately examined in terms of other physical fitness (PF) components in community-dwelling older adults. Thus, in this study, we explored factors influencing the risk of sarcopenia in community-dwelling older adults. In addition, we analyzed the clinicodemographic characteristics of older adults with or without sarcopenia and investigated the effect of sex on their PF. This cross-sectional study included 745 older adults from a community health promotion program in Taiwan. Their clinicodemographic characteristics were recorded. PF was assessed through various tests, such as hand grip strength evaluation, 8-foot up-and-go test (8-UGT), 2-min step test, and 6-m walk test. PF and factors influencing sarcopenia risk were compared between older adults with sarcopenia (sarcopenia group) and those without it (nonsarcopenia group). A logistic regression model was performed to identify key factors associated with sarcopenia. Its predictive performance was evaluated by calculating the area under the receiver operating characteristic curve (ROC) curve. Regardless of sex, the sarcopenia group performed worse in almost all components of PF-for example, upper and lower limb muscular strength and endurance, cardiopulmonary fitness, and balance-than did the nonsarcopenia group. However, for men, no significant between-group difference was observed in flexibility. The logistic regression model indicated age (odds ratio [OR]: 1.107), sex (OR: 2.881), Mini Nutritional Assessment-Short Form scores (OR: 0.690), and performance in 8-UGT (OR: 1.346) as factors influencing the risk of sarcopenia. The model exhibited excellent discriminative ability in predicting sarcopenia, as indicated by an area under the curve value of 0.867 (95% confidence interval: 0.827-0.906; p < 0.05). Older adults without sarcopenia tend to outperform those with sarcopenia in almost all PF measures, regardless of sex. Older age, male sex, low Mini Nutritional Assessment-Short Form scores, and poor performance in 8-UGT are associated with a high risk of sarcopenia.

Abstract 4124120: Rare but Deadly - Eosinophilic Myocarditis in a Patient with Eosinophilic Granulomatosis Polyangiitis

Eosinophilic myocarditis (EM) is a rare inflammatory myocarditis characterized by eosinophilic infiltration of myocardial tissue. Despite the high mortality rate, EM is frequently underdiagnosed and is often first identified in postmortem studies. We share a case of EM as an early manifestation of newly diagnosed eosinophilic granulomatosis polyangiitis (EGPA). The patient is a 46-year-old female with a past medical history of ulcerative colitis and adult-onset asthma who presented to the emergency department with a 2–3-week history of worsening positional chest pain radiating to the left upper extremity. Associated symptoms include 3 months of fatigue, headaches, right foot neuropathy, urticaria, and B-symptoms. Prior to admission, the patient was started on empiric prednisone for presumed EGPA. Initial lab work on admission was notable for elevated troponin (602 ng/L), hyper-eosinophilia (19.5%), thrombocytosis (680K/uL), and elevated ESR (42 mm/h) that have improved since initiation of prednisone. Transthoracic echocardiogram revealed a newly reduced LVEF of 40% with basal and mid-septal wall motion abnormalities. Cardiac catheterization showed normal coronaries confirming the diagnosis of non-ischemic cardiomyopathy. Late gadolinium enhancement in cardiac MRI was seen in basal to mid segments with patchy pericardial enhancement, meeting the Lake Louise criteria for myocarditis. An endomyocardial biopsy showed substantial myocardial infiltration with lymphocytes, histiocytes and eosinophils, confirming the diagnosis of EM. After multidisciplinary team discussion with cardiology and rheumatology, the patient was started on guideline-directed medical therapy for her HFrEF and pulse dose steroids with a prolonged taper and cyclophosphamide. She is tolerating her treatment well. This case highlights the importance of early recognition, comprehensive assessment and targeted treatment for EM depending on its underlying etiology. In the case of autoimmune dysfunction, it involves a combination of immunosuppressive and symptomatic therapy. Ongoing research is crucial to enhance our understanding and improve clinical outcomes, like arrhythmias and cardiogenic shock, for this complex condition.

Adjustable compression wraps: back to the future

Adjustable Compression Wraps (ACWs) are used to treat a variety of conditions, in particular venous leg ulcers, edema and lymphedema. Publications on the use of these devices are ultimately few and far between, with limitations or biases (small sample sizes, methodological weaknesses, non-comparative studies, lack of interface pressures). A development model like that used in the study of a drug could be more rational. We propose five phases: phase 1) discovery and development, phase 2) in vitro testing, phase 3) clinical trials, phase 4) real-life data analysis, medico-economic investigation using Artificial Intelligence (AI), and phase 5) preparation of regulatory dossiers. This lack of coherence in development could be an obstacle to widespread clinical use. Using AI to analyse large quantities of data could reduce the cost and number of clinical trials needed to generate more robust evidence. This would make it possible to better define the clinical effects of ACWs in specific situations (e.g., leg wounds in the elderly, diabetic wounds, mixed leg ulcers, secondary lymphedema of the upper limb, efficacy, and comfort...) and to compare treatment costs between bandages and ACWs. If we don't explore the future with AI, we'll never know what will be useful for the present - hence the title “Back to the Future”.

Effects of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper limb motor function after stroke: a systematic review and meta-analysis

ObjectiveTo evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS) on upper limb motor dysfunction after stroke.MethodsWe systematically searched databases up to May 2024, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, Wanfang, and CBM. Randomized controlled trials (RCTs) examining the application of rTMS combined rPMS on upper limb motor dysfunction after stroke were included based on predefined inclusion criteria. We used Cochrane Risk of Bias 2 tool to assess bias risk of the included RCTs. Meta-analysis was conducted using RevMan 5.4 and Stata 17.0 software.ResultsA total of 9 RCTs involving 483 participants were included in this study. Compared with the control groups that used either conventional therapy or rTMS alone, the experimental group that used rTMS combined rPMS showed significant improvements in stroke patients' upper limb motor function [MD = 3.65, 95% CI (2.75, 4.54), P &amp;lt; 0.05], ability of daily living [MD = 4.50, 95% CI (3.50, 5.50), P &amp;lt; 0.05], and spasticity [MD = –0.34, 95% CI (−0.48, −0.20), P &amp;lt; 0.05]. Meanwhile, in terms of neurophysiological indicators, significant differences were found both for motor evoked potential latency [MD = −1.77, 95% CI (−3.19, −0.35), P &amp;lt; 0.05] and motor evoked potential amplitude [MD = 0.25, 95% CI (0.01, 0.49), P &amp;lt; 0.05].ConclusionThis study provides low-level evidence that the therapy of LF-rTMS or HF-rTMS combined with rPMS can improve the upper limb motor function and daily living ability of stroke patients. However, given that the low quality of the evidence for the evaluation results, further evidence from high-quality studies is needed to substantiate this conclusion.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024539195, PROSPERO Platform [CRD42024539195].

Long-term outcome for patients with distal radius fractures treated with volar locking plates versus percutaneous wires.

Fractures of the distal radius are the most common fractures of the upper extremity. The choice of surgical method has been debated and studies show that short-term differences, in favour of volar locking plates, are indistinguishable at 1 year follow-up. Few studies have investigated long-term outcomes beyond one year. The aim of this study was to investigate long-term (6-10 years) patient-reported outcomes after distal radius fracture surgery, and to determine how fracture pattern/complexity (Buttazzoni fracture type) affects the results. 303 patients surgically treated for a distal radius fracture, from 2012-2016 were included. The questionnaires used were PRWE, Quick-DASH and EQ-5D. Previous studies have shown that fracture type influences the choice of surgical method and therefore fracture type was adjusted for in the statistical analysis. We found that patients treated with K-wires had significantly better Quick-DASH scores (p <0.05) and a lower degree of pain (PRWE pain scale) (p <0.05) than patients treated with volar locking plates. There was no difference between the two groups regarding the remaining outcome measures for any Buttazzoni type of fracture. On the basis of these results, K-wires can be considered an equivalent option to locking plates because of equal or better long-term outcomes, lower costs, and shorter operation times.

Abstract 4136539: Management of Malignant SVC Syndrome and Acute SVC Thrombosis with Complex Endovascular Intervention

Superior vena cava (SVC) syndrome occurs when there is SVC occlusion or obstruction. SVC obstruction can cause an increase in venous return pressure up to 40 mm Hg, producing edema of the face, neck and chest wall. Blood flow can be diverted to the right atrium through collateral venous networks in cases of gradual SVC compression. The most common cause of SVC syndrome is malignancy, as seen in 70% of cases. Traditionally, treatment is with radiation therapy but advances have now allowed for an endovascular approach. We present a case of malignant SVC syndrome with a complex percutaneous treatment approach that provided palliation with near immediate symptom improvement. A 64 year-old-female with history of cerebrovascular accident on Eliquis, right upper lobe squamous cell carcinoma of the lung in remission, and a mediastinal nodule under surveillance presented with facial and bilateral upper extremity edema. CT revealed bilateral pulmonary embolism and a large SVC thrombus causing impaired venous return. Invasive angiogram confirmed a 95% thrombotic tubular stenosis for which she underwent aspiration thrombectomy with alpha VAC F-18, then angioplasty with an Armada (Abbott) 10 x 40 mm compliant balloon and stenting with the Express (Boston Scientific) 10 x 37 mm stent. There was 0% residual stenosis and immediate clinical improvement. Oncological workup confirmed the right mediastinal mass to be a recurrence of squamous cell carcinoma. SVC syndrome occurred due to mediastinal mass compression and a near occlusive SVC thrombus. Aspiration thrombectomy was effective in treating the SVC thrombosis and was performed alongside pulmonary embolism thrombectomy. The Armada balloon is intended for lesion dilation in the peripheral arteries, but was safely used here for venous dilation. The Express stent is intended for palliation of malignant biliary neoplasms but has versatility and was utilized here for malignant neoplasm surrounding the SVC. Peripheral endovascular stenting is an advantageous treatment option for malignant SVC syndrome given the challenges due to recurrence from mass effect. This provides additional support to maintain vessel patency and is a safe palliation option for improvement in quality of life.

THE DESIGN OF A ROTATING MODULAR UPPER LIMB PROSTHETIC WRIST UNIT

This design study investigates a Prosthetic Wrist Unit for upper limb amputations using the Design Thinking methodology. It covers Problem Definition, Information Gathering, Concept Generation and Evaluation, Product Architecture, Configuration Design, Parametric Design, Detail Design, and Production. The study aims to create a small prosthetic wrist unit (50 mm diameter, 50 mm length, less than 125 gr), provides 360° rotation, connects easily with prosthetic hands, enables electric and data transfer, and is controllable via EMG sensors. This research contributes to prosthetic product design, enhancing the quality of life for amputees.

Fu's subcutaneous needling combined with scalp acupuncture for shoulder-hand syndrome phaseⅠafter cerebral infarction: a randomized controlled trial

To compare the therapeutic effect of Fu's subcutaneous needling combined with scalp acupuncture and simple scalp acupuncture for shoulder-hand syndrome phase Ⅰ after cerebral infarction. A total of 68 patients with shoulder-hand syndrome phase Ⅰ after cerebral infarction were randomized into a combination group (34 cases, 1 case dropped out) and a scalp acupuncture group (34 cases). Internal medicine treatment and conventional rehabilitation training were adopted in both groups. In the scalp acupuncture group, acupuncture was applied at parietal area and anterior parietal area of Yu's scalp acupuncture, electroacupuncture was connected for 30 min, with disperse-dense wave, in frequency of 2 Hz/100 Hz and in electric current of 1 mA, and the needles were retained for 6 h, once a day for continuous 14 days. On the basis of the treatment in the scalp acupuncture group, Fu's subcutaneous needling was applied at the affected muscles during needle retaining in the combination group, once a day in the first 3 days, once every other day in left days, 2-day interval was taken after 4-time treatment, for 14 days totally. Before and after treatment, the scores of the short form of McGill pain questionnaire (SF-MPQ), edema degree, guides to evaluation of permanent impairment (GEPI), and disabilities of the arm, shoulder and hand (DASH) were observed in the two groups, respectively, and the therapeutic effect was evaluated after treatment. After treatment, the scores of pain rating index (PRI), visual analogue scale (VAS) and present pain intensity (PPI), as well as the total scores of SF-MPQ were decreased compared with those before treatment in the two groups (P<0.05), and the above indexes in the combination group were lower than those in the scalp acupuncture group (P<0.05). After treatment, the scores of edema degree and DASH were decreased compared with those before treatment (P<0.05), while the GEPI scores were increased compared with those before treatment (P<0.05) in the two groups; in the combination group, the scores of edema degree and DASH were lower (P<0.05) while the GEPI score was higher (P<0.05) than those in the scalp acupuncture group. The total effective rate was 97.0% (32/33) in the combination group, which was superior to 91.2% (31/34) in the scalp acupuncture group (P<0.05). Both Fu's subcutaneous needling combined with scalp acupuncture and simple scalp acupuncture can effectively relieve the shoulder joint pain and edema degree of hand, improve the upper limb function in patients with shoulder-hand syndrome phase Ⅰ after cerebral infarction, and the combination therapy has better therapeutic effect than simple scalp acupuncture.

Feasibility of accelerometry in a self-directed upper limb activity program of a subacute setting with stroke survivors.

Background Wearable devices, such as accelerometers, offer novel approaches to measuring post-stroke upper limb activity. Limited studies have explored feasibility of accelerometry. Guided by the Bowen Feasibility Framework, this feasibility study aimed to examine the practicality, acceptability, and limited efficacy of accelerometry in a self-directed upper limb program with stroke survivors using a pre-post study of sequentially eligible inpatients. Method Key metrics were: practicality (60% of participants had 10hours of wear per day for 3 or more days), acceptability (adherence to recommended wear-time), and limited efficacy (correlation between Wolf Motor Function Test (WMFT) and upper limb use from accelerometry data). Results Twelve stroke survivors were recruited over 7 months, mean age 73years (range 39-94years). Eight participants (67%) met the practicality and acceptability criteria. A moderate positive correlation existed between WMFT and upper limb use at admission (r s =0.33, P =0.42) and at discharge (r s =0.42, P =0.34). Conclusion Wearable devices were feasible and acceptable for most stroke survivors, however, one-third found the devices uncomfortable, and this should be factored into sample size calculations of future studies.

A case of intraoperative detection of a central venous catheter in azygos vein arch during esophageal cancer surgery.

Central venous catheter (CVC) is often used in the perioperative management of esophageal cancer. The position of the CVC tip has been reported to shift with body positioning and, although infrequent, may traverse into the azygos vein arch. Herein, we describe a case where a migrated CVC tip in the azygous vein arch was identified during esophageal cancer surgery, preventing CVC dissection concurrent with azygous vein arch resection. A 65-year-old man was diagnosed with advanced esophageal cancer and was referred to our department for surgery after undergoing neoadjuvant chemotherapy. He underwent robot-assisted subtotal esophagectomy, followed by gastric conduit reconstruction via the posterior sternal route. Thoracic manipulation was performed with the patient in the prone position. During the surgery, a foreign body was found in the azygos vein arch, indicating that a central venous catheter had inadvertently entered the azygos vein arch. The catheter was retracted by 5cm, and after confirming that no catheter remained in the azygos arch, the azygos vein arch was separated using an autosuture device. Central venous catheter migration can occur in a various vessels. During prone esophageal cancer surgery, elevating the right upper extremity may alter the catheter tip's position from its the preoperative position. CVC amputation should be observed because the azygos vein arch is often amputated to facilitate upper mediastinal dissection during esophageal cancer surgery.

CLINICAL, EPIDEMIOLOGICAL, AND NOSOLOGICAL CHARACTERISTICS OF INJURED INDIVIDUALS WITH MASSIVE BLOOD LOSS

Severe mechanical trauma is one of the major medical and social issues in modern society, resulting in more than 5.8 million deaths worldwide each year. The leading potentially preventable cause of death in such cases is massive, uncontrolled blood loss. Objective: to study and analyze the clinical, epidemiological, and nosological characteristics of injuries, as well as age, sex, and peculiarities of traumagenesis, in order to enhance the effectiveness of emergency medical care for victims with traumatic blood loss, in accordance with the standards of evidence-based medicine. Results. The study found that trauma cases leading to massive blood loss occur more frequently in males (78.4% men vs. 21.6% women). The largest proportion of male victims are aged 21 to 30 years (21.8%). Most injuries resulted from domestic incidents (29.3%), road traffic accidents (21.2%), and criminal acts (19.2%). The most common injury types were stab wounds (40.1%) and direct blows (23.3%). In terms of injury localization, the upper limb was most commonly affected (21.9%), followed closely by the lower limb (21.6%). Individuals injured in hostilities predominantly sustained mine-blast injuries, often associated with multifactorial combined injuries. Conclusions: The clinical-epidemiological and nosological characteristics of victims with massive traumatic blood loss indicate distinct risk groups based on age, sex, type, and mechanism of injury. It has established that these clinical and epidemiological features significantly influence both the outcome of the traumatic process and the effectiveness of emergency medical care.

Balance Ability Characteristics and Related Factors in Athletes Across Different Sports: A Preliminary Study

Background: We conducted a cross-sectional study to examine two-leg- and one-leg-type balance characteristics in athletes and explore factors related to their balance ability. Methods: A total of 213 participants, including athletes from various sports (gymnastics, boat racing, swimming, soccer, judo, and baseball) and non-athletes, were included (142 men, 71 women, average age 21.5 ± 2.1 years). Balance ability was classified into two-leg and one-leg types using the modified index of postural stability (mIPS) in a two-leg stance and the one-legged stance duration with eyes closed (OLS). Body composition, upper and lower limb strength, and lower limb sensation were also measured. To examine the balance characteristics of each sport, the mIPS and OLS were used as dependent variables in a multiple regression model with age, height, weight, and sex as independent variables. Results: The results showed a significantly higher mIPS in gymnastics (estimate: 0.22) and boat racing (0.14), and it was lower in swimming (−0.25). The OLS was significantly higher in soccer (16.98), judo (16.23), gymnastics (9.77), and baseball (9.12) and significantly lower in swimming (7.93). Additionally, the mIPS was independently associated with knee extension strength (0.12), sensory motor variables (−0.004), and height (−0.01). The OLS was associated with skeletal muscle mass (1.85) and height (−1.42). Conclusions: In summary, gymnasts showed superior two-leg and one-leg balance; boat racers excelled in two-leg balance; swimmers showed inferior two-leg but better one-leg balance; and soccer, judo, and baseball athletes demonstrated superior one-leg balance. Additionally, the mIPS was associated with knee extensor strength, plantar pressure sensation, and height, whereas the OLS was associated with skeletal muscle mass and height.

EPCO-59. FIRST CASE REPORT OF COMBINED GERMLINE NF1 AND BRCA2 MUTATIONS PRESENTED WITH NEUROFIBROMAS AND LIPOMATOSIS

Abstract Both Neurofibromatosis type 1(NF1) and BRCA2 are common tumor suppressor genes, with mutations in each associated with genetic tumor syndromes. However, it is extremely rare to observe two different germline mutations in one patient. To the author’s knowledge, this is the first case report of a patient with germline mutations in both pathological NF1 and BRCA2 genes. We report a 41-year-old male patient with neurofibromas and lipomatosis. The patient with known family history of NF1, was diagnosed with NF1 after skin biopsy at 28 years old. At 40 years old, he underwent resection of a large intrathoracic neurofibroma. For genetic confirmation, next generation sequencing test was performed on both the intrathoracic neurofibroma tumor sample and saliva sample, revealing unexpected pathological germline mutation in both NF1 and BRCA2 genes. Consequently, the patient underwent resection of multiple lesions in the chest, abdomen, and upper extremities due to concern for potential breast cancers, and pathology of these lesions predominantly showed lipomas and one angiolipoma. Patient has family members with NF1 including a maternal aunt, a maternal cousin, and one son. However, there is no family history of lipomatosis or cancers commonly associated with BRCA2 mutation such as breast, ovarian, pancreatic, or prostate cancer. While lipomas are reported in patients with NF1, it is unusual that patient does not have typical café-au-lait spots or multiple neurofibromas but instead has multiple lipomas. This unusual presentation may be related to his unique genetic condition involving germline mutations in two tumor suppressor genes. Long term follow-up with screening tests for known tumors associated with each genetic mutation will be essential.

Important features of bench press performance in non-disabled and Para athletes: A scoping review.

Understanding important features for performance in non-disabled bench press and Paralympic powerlifting may inform talent identification and transfer models. The aim of this scoping review was to describe features associated with bench press performance. We conducted a systematic search of three electronic databases (PubMed, SportDiscus and EMBASE) to identify studies involving non-disabled and Para athlete populations that investigated features related to bench press one-repetition maximum (1RM), across six domains (anthropometric, body composition, demographic, technical, disability and neuromuscular). Search terms included "resistance training", "para powerlifting' and "one repetition max". No date restrictions were include in searches. Studies using adult participants, with at least six-months of bench press experience, who were able to bench press their body mass were included. Thirty-two studies met our inclusion criteria. Twenty-four studies involved non-disabled athletes (total n = 2,686; 21.9% female) and eight involved Para athletes (total n = 2,364; 39.4% female). Anthropometric (17 studies) and body composition (12 studies) features were most studied; half of the 32 studies investigated features from a single domain. Of anthropometric variables, upper arm circumference shared the strongest association with bench press 1RM in non-disabled (r = 0.87) and para-athletes (r = 0.65). Upper limb fat free mass (r = 0.91) and body mass index (r = 0.46) were the body composition variables sharing the strongest association with bench press 1RM in non-disabled and para-athletes. Few studies considering the uncertainty of their results. Practices of open and transparent science, such as pre-registration and data sharing, were absent. The development of bench press talent identification and sport transfer models will require future studies to investigate both non-training and training modifiable features, across multiple domains. Large longitudinal studies using information from athlete monitoring databases and multivariable model approaches are needed to understand the interacting features associated with bench press performance, and for the development of talent identification models.

SURG-19. THE SYNDROME OF THE SUPPLEMENTARY MOTOR AREA: CLINICAL COURSE AND PREDICTORS OF OUTCOME AFTER RESECTION OF PREMOTOR LESIONS

Abstract OBJECTIVE Supplementary motor area (SMA) syndrome frequently occurs after resection of premotor lesions. Interhemispheric connectivity including the contralateral SMA might be crucially involved in its development and recovery. We aimed to identify predictors of outcome by quantifying preoperative structural alterations in the non-affected contralateral hemisphere. METHODS We retrospectively searched our database for patients developing SMA syndrome after resection of premotor lesions between 2013 and 2023. Clinical characteristics and imaging data were collected. Structural network analysis was performed using the previously validated morphometric inverse divergence network. RESULTS 27 patients with a mean age of 39.2 ± 17.7 years developed SMA syndrome, including 13/27 patients (48.1%) with primary brain tumors and 14/27 patients (51.9%) with intractable lesional epilepsy. Postoperative SMA syndrome was commonly characterized by contralateral upper extremity hemiparesis (19/27 patients, 70.4%) and aphasia in case of dominant hemisphere involvement (13/13 patients, 100%). Tumor patients were less likely to fully recover from SMA syndrome after 7 days compared to epilepsy patients (2/13 [15.4%] versus 9/14 [64.3%] patients, p=0.018). Most patients (23/27, 85.2%) experienced full recovery of SMA syndrome after a median follow-up of 5 months (IR 3-16 months), with no difference between patients with tumors or epilepsy (p=0.999). Preoperative contralateral intra-hemispheric connectivity was similar between patients receiving tumor or focal resection (0.183 vs 0.177, p=0.295). However, imaging analyses demonstrated baseline affection of SMA connectivity in patients with brain tumors as characterized by reduced cortical thickness of the contralateral frontal lobe and the cingulate gyrus compared to epilepsy patients. CONCLUSION While full recovery from SMA syndrome is common, SMA syndrome is frequently less severe and more transient in patients with epilepsy. This might be due to affection of the contralateral SMA network in tumor patients due to the infiltrative nature of the disease. Imaging analyses might assist in identifying network affections at baseline.

Clinical Utility of Bioimpedance Analysis for Upper Limb Lymphedema with Surgical Treatment.

Background: In lymphedema, the accumulation of subcutaneous interstitial fluid is the most characteristic feature. Bioimpedance analysis (BIA) is a promising technique to measure the amount of body components using a noninvasive method. In this study, we determined the clinical significance of BIA parameters in upper limb lymphedema with surgical treatment such as lymphovenous anastomosis or vascularized lymph node transfer. Methods and Results: A single-center retrospective study using a multifrequency BIA. Perioperative BIA parameters such as extracellular water ratio or fat-free mass (FFM) ratio and limb volume defined as percentage of excess volume (PEV) were measured. The relationships between the magnitude of change in PEV and BIA parameters during surgery were evaluated. Out of 48 unilateral lymphedema patients, 46 were female and the average age was 55.4 years. PEV and all BIA parameters showed a significant decrease after surgery (p < 0.001). There were significant correlations between ΔPEV and the degree of changes in all BIA parameters. ΔFFM ratio showed the highest correlation with the amount of change in PEV (r = 0.599, p < 0.001). Conclusion: BIA parameters correlated well with the volume change after surgery. BIA could be useful as a quick and easy tool for follow-up after lymphedema surgery.