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Grounded in the aging and complexity literature, this experimental study investigated the moderating role of individuals’ cognitive age on the impact of recommendation agent (RA) comprehensiveness (i.e., amount of detail involved in using an RA) on users’ perceptions regarding RA complexity and RA usefulness. An experiment involving 140 online shoppers was conducted to understand the experiences of cognitively younger and older adults while using low or high comprehensiveness RAs designed for this study. Results reveal the tension that exists for older adults when using highly comprehensive RAs, as they perceive them to be more complex but also more useful in providing recommended products. The finding that cognitively older adults perceive high comprehensiveness RAs to be more useful compared to low comprehensiveness RAs provides a novel insight to the information systems literature, as it is contrary to the prevalent belief that “the older the user, the simpler the information technology should be.” Theoretically, this study improves our understanding of how increasing levels of RA comprehensiveness differentially affects the perceptions of RA complexity and RA usefulness of users of different cognitive ages. For practitioners, the results provide important guidelines about the kind of RA that is appropriate for consumers with different cognitive ages.

ObjectivesRheumatoid arthritis (RA) has been associated with a relative expansion of faecal Prevotellaceae. To determine the microbiome composition and prevalence of Prevotella spp. in a group of individuals at increased risk for RA, but prior to the development of the disease.MethodsIn an ongoing cohort study of first-degree relatives (FDRs) of patients with RA, we identified ‘FDR controls’, asymptomatic and without autoantibodies, and individuals in pre-clinical RA stages, who had either developed anticitrullinated peptide antibodies or rheumatoid factor positivity and/or symptoms and signs associated with possible RA. Stool sampling and culture-independent microbiota analyses were performed followed by descriptive statistics and statistical analyses of community structures.ResultsA total of 133 participants were included, of which 50 were categorised as ‘FDR controls’ and 83 in ‘pre-clinical RA stages’. The microbiota of individuals in ‘pre-clinical RA stages’ was significantly altered compared with FDR controls. We found a significant enrichment of the bacterial family Prevotellaceae, particularly Prevotella spp., in the ‘pre-clinical RA’ group (p=0.04).Conclusions Prevotella spp. enrichment in individuals in pre-clinical stages of RA, before the onset of RA, suggests a role of intestinal dysbiosis in the development of RA.

Background. Ageing of the society is progressively increasing the incidence of rheumatoid arthritis (RA) in the ederly, but the clinical characteristics and outcomes of late-onset RA (LORA) remain debated. If, on the one-hand, some forms of LORA have traditionally been regarded as more benign, older age is also reported as a risk factor for disease refractoriness. Aim of this study was to investigate the clinical outcomes of newly diagnosed LORA in comparison with young-onset RA (YORA) in the setting of a standardized treatment protocol, taking into account possible differences according to autoantibody status.   Methods. Data were retrieved from a monocentric inception cohort of patients with new onset (symptoms <12 months) RA, tightly followed at 3-months intervals and treated according to a treat-to-target strategy with progressively increasing doses of methotrexate (MTX). Patients were classified as LORA based on the newly proposed cut-off of >= 70 years. Outcomes of interest included proportions of patients in remission at 6 and 12 months, and doses of MTX at each time point. Analyses were stratified for positivity of anti-citrullinated protein autoantibodies (ACPA).   Results. Among 812 patients with early RA, 239 (29.2%) had LORA. Collectively, compared with YORA, LORA presented with higher inflammatory features, including numbers of involved joints and acute phase reactants (Table 1). After 6 and 12 months of treatment, rates of remission according to the DAS28, SDAI and Boolean criteria were comparable between LORA and YORA. Doses of MTX at 12 months did not differ (mean [SD] 13.8 [4.9] vs 13.9 [5.9] mg/w). LORA was significantly less frequent among ACPA-positive patients (16.4% vs 34.8%, p<0.001). However, in this latter serologic subgroup, LORA was characterized by more unfavourable outcomes compared with YORA, with lower rates of remission at each time point in spite of comparable doses of MTX (Table 1). At multivariable analyses corrected for gender, baseline disease activity and use of prednisone, LORA predicted failure to achieve remission at 12 months with an ORs (95% CI) of 2.7 (0.09-0.77). In contrast, in ACPA-negative patients, LORA was characterized by more frequent achievement of remission according to any criterion and at each time-point compared with YORA (Table 1). Also, the required dose of MTX tended to be lower in LORA. In ACPA-negative RA, LORA predicted early remission with an adjusted OR (95% CI) of 1.98 (1.08-3.64).   Conclusions Older age at onset has opposite outcomes in RA in relation to the autoantibody status. In ACPA-positive patients, those with LORA exhibit poorer response to first line-treatment with MTX. In contrast, the ACPA-negative subgroup of LORA has an overall milder course of the disease, with more frequent achievement of good clinical outcomes and lower therapeutic burden.

Gut microbiota dysbiosis has been implicated in rheumatoid arthritis (RA) and influences disease progression. Although molecular and culture‐independent studies revealed RA patients harbored a core microbiome and had characteristic bacterial species, the lack of cultured bacterial strains had limited investigations on their functions. This study aimed to establish an RA‐originated gut microbial biobank (RAGMB) that covers and further to correlates and validates core microbial species on clinically used and diagnostic inflammation and immune indices. We obtained 3200 bacterial isolates from fecal samples of 20 RA patients with seven improved and 11 traditional bacterial cultivation methods. These isolates were phylogenetically identified and selected for RAGMB. The RAGMB harbored 601 bacterial strains that represented 280 species (including 43 novel species) of seven bacterial phyla. The RAGMB covered 93.2% at species level of medium‐ and high‐abundant (relative abundances ≥0.2%) RA gut microbes, and included four rare species of the phylum Synergistota. The RA core gut microbiome was defined and composed of 20 bacterial species. Among these, Mediterraneibacter tenuis and Eubacterium rectale were two species that statistically and significantly correlated with clinically used diagnostic indices such as erythrocyte sedimentation rate (ESR) and IL‐10. Thus, M. tenuis and E. rectale were selected for experimental validation using DSS‐treated and not DSS‐treated mice model. Results demonstrated both M. tenuis and E. rectale exacerbated host inflammatory responses, including shortened colon length and increased spleen weight, decreased IL‐10 and increased IL‐17A levels in plasma. Overall, we established the RAGMB, defined the RA core microbiome, correlated and demonstrated core microbial species effected on host inflammatory and immune responses. This work provides diverse gut microbial resources for future studies on RA etiology and potential new targets for new biomedical practices. Intensive collection of 3200 bacterial isolates from fecal samples of newly diagnosed rheumatoid arthritis (RA) patients resulted in an RA‐originated gut microbial biobank (RAGMB). This RAGMB has 601 strains that represent 280 bacterial species (including 43 novel species), and covers 93.2% of medium‐ and high‐abundant gut microbial species of the RA fecal samples. By integrating additional RA cohort metagenomic data, an RA core microbiome composing of 20 core microbial species were defined and correlated to RA clinical indices. Two RA core microbial species, Mediterraneibacter tenuis and Eubacterium rectale, were selected for experimental validation with mouse models and the results showed that both M. tenuis and E. rectale exacerbated host inflammatory and immune responses. Highlights An rheumatoid arthritis (RA)‐originated gut microbial biobank (RAGMB) was established, comprising 601 bacterial strains representing 280 species (including 43 novel species) across seven bacterial phyla. RAGMB covers 93.2% of medium‐ and high‐abundant RA gut microbe species from isolated samples. The RA core microbiome consists of 20 bacterial species, with Mediterraneibacter tenuis and Eubacterium rectale showing significant correlations with clinical indices such as ESR and IL‐10. RA core species Mediterraneibacter tenuis and Eubacterium rectale exacerbate inflammatory responses, including shortened colon length, enlarged spleen and altered plasma cytokine levels.

Background and AimsSciatic nerve block is widely used alone or in association with other nerve blocks for lower limb surgeries. For below knee surgical procedures distal sciatic nerve block is frequently used. When long acting local anaesthetic such as Bupivacaine is administered irrespective of nerve localization technique complete sensory and motor block are often associated with slow onset of time which is usually 20 - 60 minutes.This study aimed to evaluate and compare the onset of action of sciatic nerve block when given proximal to its bifurcation and immediately after its bifurcation into Tibial and Common peroneal nerves under ultrasound guidance.MethodsUltrasound guided sub paraneural popliteal sciatic nerve block was performed in 50 patients undergoing lower extremity surgeries. These patients were randomly divided into group A and group B. Where in group A, patients received 20 ml of 0.5% Bupivacaine 8 cm above the bifurcation and in group B, patients received 20 ml of 0.5% Bupivacaine immediately after the bifurcation of sciatic nerve into Tibial and Common peroneal nerves. The performance time and adverse events were recorded.ResultsPatients in group A had shorter onset of both sensory and motor block compared to group B which is statistically significant.Abstract B19 Figure 1Abstract B19 Figure 2Total time taken to perform sciatic nerve block was comparable between the groups.ConclusionsPopliteal sciatic nerve block given at pre bifurcation has faster onset of action compared to post bifurcation and block performance time was comparable and independent of BMI in both the groups

Background and AimsUltrasound-guided lumbar plexus block(ULPB) can be performed using two approaches: a parasagital (PSA) or transversal(TA). The PSA and TA have been described targeting the location of transverse process of the 4th lumbar vertebra (L4). A higher approach may promote organ puncture complication. We hypothised that TA ULPB might promote a higher level of puncture than expected.MethodsAfter informed consent, 50 volunteers were studied. Each volunteer was landmarked bilaterally, using PSA and an invisible ink pen from T12 to L5 transverse process location. A landmarked horizontal line parralel from both iliac crests was drawn. We named this line ”C”. Once we obtained the typical image of ULPB using TA passing from line C, we oriented caudaly and cephalad the probe to visualise the lumbar plexus on the level directly above and under. We named these lines ”>C” for the level above and ”

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