bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association of the Medical Research Council Scale and Quantitative Computerized Dynamometry in Patients After Critical Illness: An Exploratory Study
Authors: Michalski Anna , Souza-Barros Leanna , Robles Priscila , Cameron Jill , Herridge Margaret , Mathur Sunita
Published: May 2022

Purpose:

The purpose of this study was to determine the association between isometric peak torque obtained using the Biodex dynamometer (gold standard) to the Medical Research Council (MRC) scale for knee extension (KE), ankle dorsiflexion (DF), and shoulder flexion (SF) in patients after intensive care unit (ICU) discharge.

Methods:

A cross-sectional observational substudy was conducted. Adults with at least 7 days of mechanical ventilation were recruited from a parent study of outcomes after critical illness. Muscle strength of KE, DF, and SF was measured using the MRC scale (grades 0–5) and the Biodex dynamometer (peak torque, % predicted) at 3 months post-ICU discharge.

Results:

Twenty participants were included in the study. The median and interquartile ranges for MRC scores for KE, DF, and SF were 4.5 (IQR = 1), 4.5 (IQR = 1), 4.0 (IQR = 1), respectively. No significant correlations were found between isometric peak torque and MRC scores for any muscle group at 3 months post-ICU discharge.

Conclusion:

Medical Research Council scale may be limited in the ability to detect muscle weakness post-ICU discharge. Quantitative dynamometry is recommended in the post-ICU period to identify individuals with muscle weakness who may benefit from physical rehabilitation.
Eosinophilic Pustular Folliculitis of Infancy: A Histologic Assessment of 43 Cases
Authors: Fertitta Laura , Bodemer Christine , Molina Thierry , Frassati-Biaggi Annonciade , Fraitag Sylvie , Leclerc-Mercier Stéphanie
Published: May 2022

Eosinophilic pustular folliculitis of infancy is a sterile, inflammatory dermatosis that mainly affects children younger than 36 months. The underlying physiopathologic mechanism is unclear. Clinical diagnosis is challenging, and a skin biopsy may be necessary. The literature data are sometimes contradictory, and a histologic series of eosinophilic pustular folliculitis of infancy cases has not been previously published.
Case Report: Peri-oral Vascular Compromise Due to Calcium Hydroxyapatite
Authors: Virdi Gurnam S. , Spotswood Emma
Published: May 2022

The increasing popularity of nonsurgical cosmetic treatments with the use of hyaluronic acid and calcium hydroxyapatite shows how effective and versatile these treatments can be. However, this is very likely to increase the number of complications that occur. Treatment protocols exist for vascular complications due to injections with hyaluronic acids. However, protocols for such events due to injections with calcium hydroxylapatite are less defined. The author suggests an exemplified protocol for the basis of managing such life-changing complications of impending necrosis after injections with calcium hydroxyapatite.
Inferiorly Based Alar Groove Flap for Correction of Alar Base Malposition and Nasal Stenosis
Authors: Patel Niki , Horriat Narges L. , Brownlee Pamela , Humphries Laura , Hoppe Ian C.
Published: May 2022

When the external nasal valve (ENV) is excessively narrow or lacks support, nasal obstruction can develop causing decreased airflow. Although cartilage grafts may support a collapsed nasal ala, addressing severe nasal stenosis requires further intervention. Techniques to move flared ala inward are well-known; however, repositioning a medially displaced alar base is less commonly described. Our surgical team developed an inferiorly based alar groove flap to achieve lateral movement of a malpositioned alar base, with goals of widening the ENV and improving nasal symmetry and cosmesis. A retrospective chart review was performed on a series of five patients over a two-year period. Charts were reviewed for demographic data, medical and surgical history, functional airway complaints, and subjective aesthetic concerns. All patients presented with unilateral ENV collapse, alar base malposition, and nostril asymmetry. Our operative method consisted of repositioning the affected alar base laterally and inferiorly to alleviate nostril stenosis and using an alar rim graft to support the ENV. Postoperatively, all patients demonstrated immediate alleviation of subjective nasal obstruction and improvement in size of ENV aperture, nostril symmetry, and overall cosmesis. Four patients showed lasting postoperative results. One patient experienced restenosis by 4 months and required revision. Our inferiorly based alar groove flap provides a reproducible solution for repositioning a medially displaced alar base. This technique reliably corrects ENV stenosis, relieves airway obstruction, and improves nasal symmetry and cosmesis.
Survival of umbilicus on a superiorly based flap after fleur-de-lis abdominoplasty
Authors: Savva Demetris , Nittari Giulio , Gibelli Filippo , Vassiliou Andreas
Published: May 2022

Introduction:

Massive weight loss patients have a midline excess of abdominal adipose and skin tissue that contributes to an increased abdominal girth. This excess of tissue in these patients is not resolved with traditional techniques of abdominoplasty and usually the fleur-de-lis abdominoplasty technique is employed.

Patient concerns:

A 22-year-old male patient came to our clinic after a massive weight loss of 170 kg, requesting an abdominoplasty for the excess adipose and skin tissue.

Diagnosis:

Massive weight loss patient, with excess of adipose and skin tissue in the midline abdominal area.

Interventions:

Fleur-de-lis abdominoplasty technique was employed for treatment of massive weight loss.

Outcomes:

During the surgery, it was decided that the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament needed to be ligated, to remove more tissue for better aesthetic result. The umbilicus survived on the collateral blood supply from ligamentum teres and superior epigastric collaterals.

Conclusion/Lessons:

In this case report we review our experience treating a massive weight loss patient using a fleur-de-lis abdominoplasty technique without preserving the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament. We eventually relied on the collateral blood supply from ligamentum teres and superior epigastric collaterals, something that proved advantageous both in the survival of the umbilicus on the long run despite cutting off the main blood supply, and, the removal of further excess adipocutaneous tissue for a better aesthetic outcome.
The efficacy of cognitive behavior stress management on functional dyspepsia
Authors: Cheng Min , Zhou Xiu-E. , Xu Yu-Chen , Dou Hong-Mei
Published: May 2022

Background:

Functional dyspepsia and digestive disorders are common, debilitating and costly. Little information is available about the role of stress management in terms of cognitive-behavioral treatment of dyspepsia. We performed a protocol for systematic review and meta-analysis to evaluate the effectiveness of cognitive behavior stress management for the treatment of functional dyspepsia.

Methods:

A comprehensive search of several databases from 1966 to March 2022 will be conducted. The databases include Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The primary outcome for this study was the rate of successful treatment (presence of no more than mild pain or discomfort after treatment). The secondary outcomes were improvement of dyspepsia at short-term (<1 year) and long-term (≥1 year) follow up, improvement in quality of life, and development of treatment-related adverse events. The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration's risk of bias tool. The Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) will be used to analyze the data.

Results:

We will synthesize the current studies to evaluate the effectiveness and safety of cognitive behavior stress management on functional dyspepsia.

Conclusion:

The result of this review will provide more reliable references to help clinicians make decisions when dealing with functional dyspepsia.
Omicron SARS-CoV-2 variant of concern
Authors: Mohsin Md , Mahmud Sultan
Published: May 2022

Omicron, the new Covid-19 variant, has already become dominant in many countries and is spreading at an unprecedented speed. The objective of this study was to review the existing literature on Omicron's transmissibility, immune evasion, reinfection, and severity.

A literature search was performed using “PubMed,” “Web of Science,” “Scopus,” “ScienceDirect,” “Google Scholar,” “medRxiv,” and “bioRxiv.” Data were extracted from articles that reported at least one of the following: transmissibility, immune evasion, reinfection, and severity related to Omicron.

We found that Omicron spread faster than any other variant. This higher transmissibility can be ascribed to its extraordinary ability to evade the immunity developed by both vaccination and previous infections. However, we found that infections by Omicron were significantly less severe than those caused by Delta and other previous variants. We observed a significantly lower incidence of hospitalization, intensive care unit admission, and mechanical ventilator use in Omicron infections than in Delta or other variants. A substantially shorter median hospital stay and lower fatality rate were also observed in the Omicron infections. Despite Omicron's higher potential to evade immunity, vaccines and booster shots were found to be still significantly effective in protecting against severe Covid-19 infections.

Omicrons may be less severe than other variants of concern. However, its immune evasiveness and rapid spread pose an enormous threat to the global healthcare system.
Duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures
Authors: Storch Katja , Schultz Jurek , Fitze Guido
Published: May 2022

Background:

Supracondylar humerus fractures (SHF) are the second most common fracture in children and the most common fracture in children under seven years. Subtle neurovascular lesions in displaced SHF may be underdiagnosed clinically, but their sequelae can mean life-long symptoms. Here we show that color-coded duplex ultrasound (DUS) could help to identify these patients.

Methods:

We reviewed records of 229 children who had recovered from SHF. Ninety patients were available for detailed questionnaires, in-depth neurovascular examinations, and DUS.

Results:

In 90 examined patients, only two had been known to have suffered from vascular complications before our study. Only one still complained spontaneously about perfusion-induced symptoms. Qualitative changes in blood flow in duplex-sonography were detectable in both. Another two patients showed similar changes in blood flow at the fracture site. Both reported load-induced pain and paresthesia on detailed inquisition when no vascular impairments had been known before. Thus, duplex-sonography identified two patients with vascular affections that had not been noticed before in routine clinical examinations.

Conclusion:

DUS can be a sensitive tool in diagnosing vascular impairments in patients with SHF. It could reduce diagnostic insecurity, especially in anesthetized or otherwise hard to examine children, and thus help avoid the therapeutic delay that otherwise might foster life-long sequelae for the patients. More studies are needed to establish age-adjusted reference values for duplex-sonography of children's arms. Level of Evidence: Level III, Study of nonconsecutive patients (without consistently applied reference).
Impact of lenvatinib on renal function compared to sorafenib for unresectable hepatocellular carcinoma
Authors: Sasaki Ryu , Fukushima Masanori , Haraguchi Masafumi , Honda Takuya , Miuma Satoshi , Miyaaki Hisamitsu , Nakao Kazuhiko
Published: May 2022

Anti-VEGF drugs, such as tyrosine kinase inhibitors, play an important role in systemic therapy for unresectable hepatocellular carcinoma (uHCC). We examined the effects of sorafenib and lenvatinib on proteinuria and renal function.

Patients who were administered sorafenib (n = 85) or lenvatinib (n = 52) as first line treatment for uHCC from July 2009 to October 2020, were enrolled in this retrospective observational study. A propensity score analysis including 13 baseline characteristics was performed. Eighty four patients were selected (sorafenib, n = 42; lenvatinib, n = 42) by propensity score matching (one-to-one nearest neighbor matching within a caliper of 0.2). We analyzed changes in estimated glomerular filtration rate (eGFR) during tyrosine kinase inhibitor treatment, as well as the development of proteinuria in both groups. A multivariate analysis was performed to identify predictors of a deterioration of eGFR.

At 4, 8, 12, and 16 weeks, ΔeGFR was significantly lower in the lenvatinib group than in the sorafenib group (P < .05). The lenvatinib group showed a significantly higher frequency of proteinuria than the sorafenib group (30.9% vs 7.1%, P = .005) and had a higher rate of decrease in eGFR than the sorafenib group (P < .05). Multivariate analysis revealed that lenvatinib use was the only predictive factor of eGFR deterioration (odds ratio 2.547 [95% CI 1.028–6.315], P = .043). In cases of proteinuria ≤1+ during lenvatinib treatment, eGFR did not decrease. However, eGFR decreased in the long term (>24 weeks) in patients who have proteinuria ≥2+.

Lenvatinib has a greater effect on proteinuria and renal function than sorafenib. In performing multi-molecular targeted agent sequential therapy for uHCC, proteinuria and renal function are important factors associated with drug selection after atezolizumab-bevacizumab combination therapy currently used as the first-line treatment.
Observational studies: Ambient air pollution and hospitalization for RA-ILD in a heavily polluted city in China
Authors: Liu Baojin , Sun Guangzhi , Liu Ying , Hou Yanfeng
Published: May 2022

Little is known within the medical community about the impact of air pollution on hospital admissions due to rheumatoid arthritis associated with interstitial lung disease (RA-ILD). Our research aimed to explore whether there is a correlation and to estimate how the association was distributed across various lags in Jinan, China.

The relationships between ambient air pollutant concentrations, including PM2.5, PM10, sulfur dioxide (SO2), ozone (O3), and nitrogen dioxide (NO2), and monthly hospitalizations for RA-ILD were studied by employing a general linear model with a Poisson distribution. This time-series study was performed from January 1st, 2015 to December 31st, 2019.

In the 5-year study, there were 221 hospitalizations for RA-ILD in Jinan city. The levels of PM2.5, PM10, SO2, and NO2were significantly related to the number of admissions for RA-ILD. PM2.5, PM10, and SO2showed the most significant effect on the month (lag 0), and NO2was most related to RA-ILD at a lag of two months (lag 2). The monthly admissions of RA-ILD increased by 0.875% (95% CI: 0.375–1.377%), 0.548% (95% CI: 0.148–0.949%), 1.968% (95% CI: 0.869–3.080%), and 1.534% (95% CI: 0.305–2.778%) for each 10 μg/m3increase in PM2.5, PM10, SO2and NO2, respectively.

This study might add more detailed evidence that higher levels of PM2.5, PM10, SO2and NO2increase the risk of hospitalizations for RA-ILD. Further study of the role of air pollution in the pathogenesis of RA-ILD is warranted.
A Concept Development for the Symptom Science Model 2.0
Authors: Kurnat-Thoma Emma L. , Graves Letitia Y. , Billones Ruel R.
Published: May 2022

Background

The National Institute of Nursing Research developed the National Institutes of Health symptom science model (SSM) in 2015 as a parsimonious conceptual model to guide symptom science research.

Objectives

This concept development paper synthesizes justifications to strengthen the original model.

Methods

A literature review was performed, discussions with symptom science content expert stakeholders were held, and opportunities for expanding the current model were identified. Concept elements for a revised conceptual model—the SSM 2.0—were developed.

Results

In addition to the four original concept elements (complex symptom presentation, phenotypic characterization, biobehavioral factors [previously biomarker discovery], and clinical applications), three new concept elements are proposed, including social determinants of health, patient-centered experience, and policy/population health.

Discussion

There have been several calls to revise the original SSM from the nursing scientific community to expand its utility to other healthcare settings. Incorporating three additional concept elements can facilitate a broader variety of translational nursing research symptom science collaborations and applications, support additional scientific domains for symptom science activities, and produce more translatable symptom science to a wider audience of nursing research scholars and stakeholders during recovery from the COVID-19 pandemic. The revised SSM 2.0 with newly incorporated social determinants of health, patient-centered experience, and policy/population health components now empowers nursing scientists and scholars to address specific symptom science public health challenges particularly faced by vulnerable and underserved populations.
Rehabilitation definition for research purposes. A global stakeholders’ initiative by Cochrane Rehabilitation
Authors: Negrini Stefano , Selb Melissa , Kiekens Carlotte , Todhunter-Brown Alex , Arienti Chiara , Stucki Gerold , Meyer Thorsten
Published: May 2022

Objective

Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: 1) support the conduct of primary studies and systematic reviews, and 2) identify relevant systematic reviews for knowledge translation purposes.

Design

We performed a multimodal study including seven preliminary research and discussion papers, four Consensus Meetings and three Delphi rounds with 80 rehabilitation stakeholders. The Delphi Study aimed to obtain agreement, refine and complete the items composing the definition and meanings of rehabilitation. These stakeholders covered 5 continents, representing 11 global and continental rehabilitation organizations, 11 scientific journals, 4 Cochrane Networks and 3 Cochrane Groups, and included invited experts, and representatives of low middle-income countries (LMICs) and consumers.

Results

We had a 70% to 82.5% response rate to the three Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range 5.5-50% per item). This participation led to several refinements to the rehabilitation definition through three preliminary versions, and the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework. We concluded that “In a health care context,” rehabilitation is defined as a “multimodal, person-centered, collaborative process” (Intervention-general), including interventions targeting a person’s “capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance” (Intervention-specific) with the goal of “optimizing” the “functioning” (Outcome) of “persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability” (Population). Rehabilitation requires that all the items of the definition are satisfied. We defined a “rehabilitation intervention” as “any intervention provided within the rehabilitation process.”

Conclusion

We developed a rehabilitation definition for research purposes achieving a broad agreement with global stakeholders. This definition provides explicit criteria to define rehabilitation. Using the proposed definition will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation.
External and internal work load during a mountain time trial in trained handcyclists vs. a world class handcyclist and determinants of performance
Authors: de Groot Sonja , Kouwijzer Ingrid , Hoekstra Sven P. , Vroemen Guido , Valent Linda J.M. ,   HandbikeBattle group, van der Woude Lucas H.V.
Published: May 2022

Objective

To evaluate the external and internal work load of trained handcyclists during a mountain time trial, to compare the results with a world class (WC) handcyclist, and to identify time trial performance determinants.

Design

Ten trained and one WC handcyclists performed a graded exercise test to determine power output (PO) and heart rate (HR) at the ventilatory thresholds (VT1 and VT2) and exhaustion. PO and HR were continuously measured during the race.

Results

Absolute POmeanrace (119 ± 21 vs. 203 W, p < 0.001) was lower in the trained handcyclists compared to the WC handcyclist. Absolute and relative HRrace (86 ± 7% vs. 88%, p = 0.40) and relative POrace (66 ± 10% vs. 62%, p = 0.24) were similar. Trained handcyclists cycled significantly less time at a PO between VT1-VT2 (48% vs. 64%, p = 0.02) and more at a PO > VT2 (34% vs. 11%, p = 0.005). POVT2 showed the strongest correlation with finish time (r = -0.78) and POpeak with POmeanrace (r = 0.90).

Conclusion

Lab outcomes POpeak and POVT2 are important performance determinants for longer time trials in handcyclists and it is, therefore, important to improve these outcomes with training. Since the trained handcyclists cycled most of the race in intensity zones 2 and 3, it is recommended to incorporate these zones also in the training.
Temporal trend of opioid and nonopioid pain medications: results from a national in-home survey, 2001 to 2018
Authors: Wang Yun , Wu Dan , Chan Alexandre , Chang Chih-Hung , Lee Vivian W.Y. , Nichol Michael B.
Published: May 2022

Introduction:

The opioid epidemic persists in the United States. The use of opioid medications is often assessed by claims data but potentially underestimated.

Objectives:

We evaluated the temporal trend in the use of opioid and nonopioid pain medications from a national survey.

Methods:

Using data from the 2001 to 2018 National Health and Nutrition Examination Survey (NHANES), we examined the current use of prescription analgesics in the past 30 days among 50,201 respondents aged 20 years or older. Joinpoint regressions were used to test statistically meaningful trends of opioid vs nonopioid analgesics.

Results:

The mean percentage of people who had pain medications in the past 30 days was 6.4% (5.3%-7.1%) for opioid and 11.3% (9.0%-14.8%) for nonopioid analgesics. The availability of opioid and nonopioid prescriptions at home has remained stable, except for the slight decline of opioids among cancer-free patients in 2005 to 2018. The most frequently used opioid analgesic medications included hydrocodone/acetaminophen, tramadol, and hydrocodone.

Conclusion:

We uniquely measured the proportion of people who had opioid and nonopioid pain medications at home in the United States and supplemented the previous knowledge of prescription rates mainly obtained from claims data.
Fadu head and neck squamous cell carcinoma induces hyperexcitability of primary sensory neurons in an in vitro coculture model
Authors: Uhelski Megan L. , Gorur Aysegul , Shi Ted , Corrales German , Du Kim N. , Li Yan , Amit Moran , Tatsui Claudio E. , Rhines Laurence D. , Dougherty Patrick M. , Cata Juan P.
Published: May 2022

Introduction:

Currently, cancer pain is viewed as a process orchestrated by the release of pronociceptive molecules and the invasion of neural structures, referred to as perineural invasion (PNI). Cancer pain resulting from PNI is well-documented, but the mechanisms leading to peripheral sensitization because of tumor growth are not fully known.

Methods:

A retrospective study was used to examine how the use of anti-inflammatory medications affected preoperative pain in patients with oral squamous cell carcinoma cancer. We then used an in vitro coculture model in which dorsal root ganglion (DRG) neurons were incubated together with Fadu human head and neck squamous cell carcinoma cancer cells to explore how cancer cells affect the electrical membrane properties of sensory neurons.

Results:

We found that inflammation contributes to preoperative pain in patients with oral squamous cell carcinoma. After coculture with Fadu human head and neck squamous cell carcinoma cancer cells, we identified markers of inflammation in coculture media and found evidence of neuronal sensitization, including spontaneous activity, reduced current thresholds, depolarized resting membrane potential, and enhanced responses to current stimulation in human and rat DRG neurons. In rats, these effects were influenced by sex and age: neurons from young adult female rats were resistant to changes in neuronal activity, in contrast to neurons from older adult female rats or male rats of either age group.

Conclusions:

Pro-inflammatory substances released in cancer cell–DRG coculture promoted neuronal hyperexcitability and may contribute to cancer pain after PNI, and these effects may differ across age groups and sexes.
The Effect of Negative-Pressure Wound Therapy with Instillation Compared to Current Standard Care on Wound Closure Time of Infected Wounds: A Systematic Review and Meta-Analysis
Authors: Timmer Allard S. , Zwanenburg Pieter R. , Eskes Anne M. , Hompes Roel , Boermeester Marja A.
Published: May 2022

Background:

Infected wounds extend healing time and are associated with higher treatment costs than noninfected wounds. Several observational studies indicate that negative-pressure wound therapy with instillation can effectively reduce bacterial bioburden and improve wound healing. Only a few randomized trials with small sample sizes have been published, and a meta-analysis directly comparing negative-pressure wound therapy with instillation to current standard care is lacking. It is therefore uncertain whether negative-pressure wound therapy with instillation actually improves wound healing. The authors performed a systematic review and hypothesized that negative-pressure wound therapy with instillation reduces wound closure time.

Methods:

The PubMed, Embase, and CENTRAL databases were searched up to December of 2020 for English studies that compare negative-pressure wound therapy with instillation—to either negative-pressure wound therapy without instillation or to other types of wound care—for the treatment of acute or chronically infected wounds. Time to wound closure was analyzed using a random effects meta-analysis in predefined subgroups according to study design and comparative wound care.

Results:

The authors identified 14 studies describing 1053 patients. Meta-analysis of three randomized trials shows no significant difference in time to wound closure between negative-pressure wound therapy with instillation and that without (mean difference, 0.48 day; 95 percent CI, −0.70 to 1.65; I² = 0 percent). Data from eleven observational studies indicate that negative-pressure wound therapy with instillation reduces wound closure time (from 1.6 to 16.8 days; no pooled data). Because of imprecision and risk of bias, the available evidence provides only low-level certainty.

Conclusions:

There is currently insufficient evidence to support or discard the use of negative-pressure wound therapy with instillation for infected wounds. More randomized trials are needed to determine whether a beneficial effect can be substantiated.
Reducing Complications and Expanding Use of Robotic Rectus Abdominis Muscle Harvest for Pelvic Reconstruction
Authors: Davila Armando A. , Goldman Joshua , Kleban Shawna , Lyons Mitchell , Brosious John , Bardakcioglu Ovunc , Baynosa Richard C.
Published: May 2022

The rectus abdominis flap has long been a workhorse in perineal reconstruction. Although traditionally approached though an external incision, the morbid nature of the incision and subsequent violation of the anterior rectus sheath has encouraged innovation of minimally invasive approaches for harvest. In this study, we present our experience, evolution, and comparative outcomes of robotic rectus abdominis muscle harvest. A retrospective review of perineal reconstruction was performed for a 6-year period (2014 to 2019). Robotic rectus abdominis muscle flaps were compared to nonrobotic techniques performed during this time. Descriptive statistics and complication profiles were computed. The details of our surgical technique are also described. Thirty-six patients underwent perineal reconstruction. Sixteen were performed using the robotic rectus abdominis muscle and 20 with traditional repairs (12 vertical rectus abdominis myocutaneous flaps and eight gracilis flaps). Demographic profiles were similar between cohorts, including age, body mass index, smoking, diabetes, neoadjuvant radiation therapy, and need for vaginal wall repair. Six robotic patients underwent abdominal wall reinforcement with biological mesh. Length of stay, surgical times, and incidence of major complications were similar between cohorts with a trend toward increased minor complications in traditional reconstructions (55 percent versus 31 percent; p = 0.15). Robotic rectus abdominis muscle harvest is a powerful tool that continues to evolve the potential to mitigate common morbidities and complications of traditional repair and further enhance cosmetic outcomes. This study suggests that greater flexibility for reconstruction can be afforded with harvest of the posterior rectus sheath and complications avoided with prophylactic mesh reinforcement.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Validity of Using the Scratch Collapse Test in the Lower Extremities
Authors: Pisquiy John J. , Carter Jordan T. , Gonzalez Gilberto A.
Published: May 2022

Background:

The scratch collapse test is a provocative test that has been successfully used for peripheral neuropathies. The elbow is the main testing site, but there may be times when use of the upper extremities is contraindicated. This study sought to determine the sensitivity of using the scratch collapse test on the lower extremity for upper extremity neuropathies.

Methods:

One hundred patients with an electromyographically confirmed diagnosis of carpal tunnel or cubital tunnel syndrome were prospectively enrolled. As a control, the scratch collapse test was conducted normally using the elbow as a testing site. After a baseline was established, the test was repeated using eversion of the foot and ankle against an inversion force.

Results:

Of the 100 study patients, 89 had a positive scratch collapse test on the upper extremity and 84 had a positive test on the lower extremity. In the 51 patients with carpal tunnel syndrome, 45 had a positive test on the upper extremity (sensitivity, 88.2 percent; 95 percent CI, 76.13 to 95.56 percent), and 42 had a positive test of the lower extremity (sensitivity, 82.35 percent; 95 percent CI, 69.13 to 91.60 percent). In the 49 patients with cubital tunnel syndrome, 44 had a positive test on the upper extremity (sensitivity, 89.8 percent; 95 percent CI, 77.77 to 96.6 percent), and 42 had a positive test on the lower extremity (sensitivity, 85.7 percent; 95 percent CI, 72.76 to 94.06 percent).

Conclusion:

There were no statistically significant differences in the sensitivities of the scratch collapse test on the upper or lower extremities, suggesting that the lower extremity could serve as an alternative site for the scratch collapse test.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, II.
Physical and Functional Outcomes of Simultaneous Vascularized Lymph Node Transplant and Lymphovenous Bypass in the Treatment of Lymphedema
Authors: Garza Rebecca M. , Beederman Maureen , Chang David W.
Published: May 2022

Background:

The authors analyze the outcomes of simultaneous vascularized lymph node transplant and lymphovenous bypass for treatment of primary and secondary lymphedema. To the best of their knowledge, this is the largest study to date with long-term outcome data of this novel approach.

Methods:

Three hundred twenty-eight patients who underwent physiologic surgical treatment over a 5.5-year period were evaluated using a prospective database and chart review. Preoperative characteristics, operative details, and postoperative outcomes (volume difference change, Lymphedema Life Impact Scale score) were assessed. Statistical analysis including multivariate regression was performed.

Results:

Two hundred twenty patients (67.1 percent) underwent simultaneous vascularized lymph node transplant and lymphovenous bypass. Mean body mass index was 26.9 ± 4.7 kg/m2. Ninety-two patients (41.8 percent) had lymphedema of the lower extremity, 121 (55.0 percent) had upper extremity involvement, and seven had lymphedema of upper and lower extremities (3.2 percent). Average duration of lymphedema was 95.4 ± 103.6 months. Thirty patients (13.6 percent) had primary lymphedema and 190 patients (86.4 percent) had secondary lymphedema. The majority improved and experienced volume reduction of an average 21.4 percent at 1 year (p < 0.0001), 36.2 percent at 2 years (p < 0.0001), 25.5 percent at 3 years (p = 0.1), and 19.6 percent at 4 years. Median Lymphedema Life Impact Scale scores were 7.0 points lower (p < 0.0001) at 3 months and improved progressively over time to 27.5 points lower at 3 years postoperatively (p < 0.005).

Conclusions:

Simultaneous vascularized lymph node transplant and lymphovenous bypass is an appropriate and effective approach for both early and advanced stages of primary and secondary lymphedema, with significant objective and subjective improvements. Volume reduction in the affected limb was observed at all time points postoperatively, with significant improvement in Lymphedema Life Impact Scale scores.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Do Preoperative Depressor Anguli Oris Muscle Blocks Predict Myectomy Outcomes? A Single-Cohort Comparison in Postparetic Facial Synkinesis
Authors: Hembd Austin S. , Sanchez Cristina V. , Halani Sameer H. , Mohanty Ahneesh J. , Krag Andreas E. , Rozen Shai M.
Published: May 2022

The complexity of facial synkinesis will likely benefit from an individualized approach to intervene on discrete synkinetic facial subunits. This overarching treatment algorithm requires understanding each synkinetic mimetic subunit. The depressor anguli oris muscle, because of its antagonistic relationship to the zygomaticus major, is of particular interest. This study aims to provide outcomes of depressor anguli oris muscle myectomies and the predictive value of preoperative lidocaine blocks. Preoperative depressor anguli oris muscle lidocaine blocks were administered to patients with postparetic facial synkinesis, and subsequent isolated depressor anguli oris muscle myectomies were performed on those who showed improvement and elected to proceed. Twenty synkinetic patients underwent isolated depressor anguli oris myectomies after lidocaine blockade, with an average follow-up of 9 months. Facial mimetic parameters and measurements were recorded and analyzed by Massachusetts Eye and Ear Infirmary Emotrics and National Institutes of Health ImageJ software to compare results from both blocks and myectomies. Both lidocaine block and depressor anguli oris myectomy improved dental show by 14.42 mm2 and 23.012 mm2, respectively, and open mouth smile angles above a horizontal plane by 4.66 and 3.32 degrees, respectively. There was no statistical difference between the groups in terms of improvements noted in closed and open mouth smile angles above a horizontal plane, or in dental show (p = 0.695, p = 0.351, and p = 0.242, respectively). Preoperative lidocaine blockade accurately predicts the improvement in dental show and modiolus smile angle that is provided by isolated depressor anguli oris muscle myectomy. This furthers our understanding of depressor anguli oris muscle abnormality in the overall spectrum of facial synkinesis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Modified thyroidectomy: 4 techniques to prevent recurrent laryngeal nerve injury and postoperative hypocalcaemia
Authors: Salih Abdulwahid M. , Baba Hiwa O. , Ahmed Mohsin M. , Kakamad Fahmi H. , Hassan Hunar A. , Hassan Marwan N. , Abdulla Berwn A. , Muhialdeen Aso S. , Mohammed Shvan H.
Published: May 2022

Objective:

To share 4 techniques that decrease the rate of postoperative hypocalcaemia and save recurrent laryngeal nerve with a good cosmetic outcome.

Method:

The research included all consecutive patients of thyroidectomy (hemi and total thyroidectomy) during 4-year practice. The techniques included (1) elevation of a circular flap after 4 cm collar incision. (2) Ligation of the pedicles (middle first-vein, inferior last-artery). (3) Sharp dissection of the parathyroid glands. (4) Sharp and blunt dissection and exposing the nerve in all of the patients.

Result:

The total numbers of patients were 2399. At least 1 symptom of hyperthyroidism was found in 1271 patients (53%). The main indication for operation was multinodular goiter and compression symptoms in 1331 (55.5%) patients, followed by thyrotoxicosis in 598 (25%) patients and malignancy in 402 (16.8%) patients. The most common operations were total thyroidectomy in 1880 (78.4%) patients, followed by thyroid lobectomy in 495 (20.6%) patients and completion thyroidectomy in 24 (1%) patients. Among all patients, 4 (0.16%) patients developed permanent voice change. Seven (0.3%) patients developed permanent hypocalcemia.

Conclusion:

This study offers a set of surgical techniques that reduced the risks of complications of thyroidectomy to a minimal range.
Opioid sparing effect of ketamine in military prehospital pain management—A retrospective study
Authors: Cohen Bar , Talmy Tomer , Gelikas Shaul , Radomislensky Irina , Kontorovich-Chen Diana , Cohen Barak , Benov Avi , Avital Guy
Published: May 2022

BACKGROUND

Opioids are the most commonly used analgesics in acute trauma, but are limited by slow onset and significant adverse effects. Ketamine is an effective and widely used analgesic. This study was aimed to evaluate the effectiveness and opioid-sparing effects of ketamine when used in prehospital military trauma setting.

METHODS

A retrospective analysis of a prehospital military trauma registry between 2014 and 2020. Inclusion criteria were 16 years or older, two or more documented pain assessments, at least one indicating severe pain, and administration of opioids and/or low-dose ketamine. Joint hypothesis testing was used to compare casualties who received opioids only to those who received ketamine on outcomes of pain score reduction and opioid consumption.

RESULTS

Overall, 382 casualties were included. Ninety-one (24%) received ketamine (21 as a single analgesic), with a mean dose of 29 mg (standard deviation, 11). Mean reduction in pain scores (on an 11-point scale) was not significantly different; 4.3-point (2.8) reduction in the ketamine group and 3.7 points (2.4) in the opioid-only group (p = 0.095). Casualties in the ketamine group received a median of 10 mg (interquartile range, 3.5–25) of morphine equivalents (MEs) compared with a median of 20 ME (10, 20) in the opioid-only group. In a multivariable multinomial logistic regression, casualties in the ketamine group were significantly more likely to receive a low (1–10 ME) rather than a medium (11–20 ME) dose of opioids compared with the opioid-only group (odds ratio, 0.032; 95% confidence interval, 0.14–0.75).

CONCLUSION

The use of ketamine in the prehospital military setting as part of a pain management protocol was associated with a low rather than medium dose of opioids in a multivariable analysis, while the mean reduction in pain scores was not significantly different between groups. Using ketamine as a first-line agent may further reduce opioid consumption with a similar analgesic effect.

LEVEL OF EVIDENCE

Therapeutic/care management; Level IV.
Measuring Real-Time Medication Effects From Electroencephalography
Authors: Sathyanarayana Aarti , El Atrache Rima , Jackson Michele , Cantley Sarah , Reece Latania , Ufongene Claire , Loddenkemper Tobias , Mandl Kenneth D. , Bosl William J.
Published: May 2022

Purpose:

Evaluating the effects of antiseizure medication (ASM) on patients with epilepsy remains a slow and challenging process. Quantifiable noninvasive markers that are measurable in real-time and provide objective and useful information could guide clinical decision-making. We examined whether the effect of ASM on patients with epilepsy can be quantitatively measured in real-time from EEGs.

Methods:

This retrospective analysis was conducted on 67 patients in the long-term monitoring unit at Boston Children's Hospital. Two 30-second EEG segments were selected from each patient premedication and postmedication weaning for analysis. Nonlinear measures including entropy and recurrence quantitative analysis values were computed for each segment and compared before and after medication weaning.

Results:

Our study found that ASM effects on the brain were measurable by nonlinear recurrence quantitative analysis on EEGs. Highly significant differences (P < 1e-11) were found in several nonlinear measures within the seizure zone in response to antiseizure medication. Moreover, the size of the medication effect correlated with a patient's seizure frequency, seizure localization, number of medications, and reported seizure frequency reduction on medication.

Conclusions:

Our findings show the promise of digital biomarkers to measure medication effects and epileptogenicity.
Motor synergy generalization framework for new targets in multi-planar and multi-directional reaching task
Authors: Kutsuzawa Kyo , Hayashibe Mitsuhiro
Published: May 2022

Humans can rapidly adapt to new situations, even though they have redundant degrees of freedom (d.f.). Previous studies in neuroscience revealed that human movements could be accounted for by low-dimensional control signals, known as
motor synergies
. Many studies have suggested that humans use the same repertories of motor synergies among similar tasks. However, it has not yet been confirmed whether the combinations of motor synergy repertories can be re-used for new targets in a systematic way. Here we show that the combination of motor synergies can be generalized to new targets that each repertory cannot handle. We use the multi-directional reaching task as an example. We first trained multiple policies with limited ranges of targets by reinforcement learning and extracted sets of motor synergies. Finally, we optimized the activation patterns of sets of motor synergies and demonstrated that combined motor synergy repertories were able to reach new targets that were not achieved with either original policies or single repertories of motor synergies. We believe this is the first study that has succeeded in motor synergy generalization for new targets in new planes, using a full 7-d.f. arm model, which is a realistic mechanical environment for general reaching tasks.
Opinion dynamics in social networks under competition: the role of influencing factors in consensus-reaching
Authors: Lang Ningning , Wang Lin , Zha Quanbo
Published: May 2022

The rapid development of information technology and social media has provided easy access to the vast data on individual preferences and social interactions. Despite a series of problems, such as privacy disclosure and data sensitivity, it cannot be denied that this access also provides beneficial opportunities and convenience for campaigns involving opinion control (e.g. marketing campaigns and political election). The profitability of opinion and the finiteness of individual attention have already spawned extensive competition for individual preferences on social networks. It is necessary to investigate opinion dynamics over social networks in a competitive environment. To this end, this paper develops a novel social network DeGroot model based on competition game (DGCG) to characterize opinion evolution in a competitive opinion dynamics. Social interactions based on trust relationships are captured in the DGCG model. From the model, we then obtain equilibrium results in a stable state of opinion evolution. We also analyse what role relevant factors play in the final consensus and competitive outcomes, including the resource ratio of both contestants, initial opinions, self-confidence and network structure. Theoretical analyses and numerical simulations show that these factors can significantly sway the consensus and even reverse competition outcomes.
Viewing the rare through public lenses: insights into dead calf carrying and other thanatological responses in Asian elephants using YouTube videos
Authors: Pokharel Sanjeeta Sharma , Sharma Nachiketha , Sukumar Raman
Published: May 2022

Documenting the behavioural repertoire of an animal species is important for understanding that species' natural history. Many behaviours such as mating, parturition and death may be observed only rarely in the wild due to the low frequency of occurrence, short duration and the species' elusiveness. Opportunistic documentation of rare behaviours is therefore valuable for deciphering the behavioural complexity in a species. In this context, digital platforms may serve as useful data sources for studying rare behaviours in animals. Using videos uploaded on YouTube, we document and construct a tentative repertoire of thanatological responses (death-related behaviours) in Asian elephants (Elephas maximus). The most frequently observed thanatological responses included postural changes, guarding/keeping vigil, touching, investigating the carcass, epimeletic behaviours and vocalizations. We also describe some infrequently observed behaviours, including carrying dead calves by adult females, re-assurance-like behaviours and attempts to support dying or dead conspecifics, some of which were only known anecdotally in Asian elephants. Our observations indicate the significance of open-source video data on digital platforms for gaining insights into rarely observed behaviours and support the accumulating evidence for higher cognitive abilities of Asian elephants in the context of comparative thanatology.
Inelastic scattering of electrons in water from first principles: cross sections and inelastic mean free path for use in Monte Carlo track-structure simulations of biological damage
Authors: Koval Natalia E. , Koval Peter , Da Pieve Fabiana , Kohanoff Jorge , Artacho Emilio , Emfietzoglou Dimitris
Published: May 2022

Modelling the inelastic scattering of electrons in water is fundamental, given their crucial role in biological damage. In Monte Carlo track-structure (MC-TS) codes used to assess biological damage, the energy loss function (ELF), from which cross sections are extracted, is derived from different semi-empirical optical models. Only recently have first
ab initio
results for the ELF and cross sections in water become available. For benchmarking purpose, in this work, we present
ab initio
linear-response time-dependent density functional theory calculations of the ELF of liquid water. We calculated the inelastic scattering cross sections, inelastic mean free paths, and electronic stopping power and compared our results with recent calculations and experimental data showing a good agreement. In addition, we provide an in-depth analysis of the contributions of different molecular orbitals, species and orbital angular momenta to the total ELF. Moreover, we present single-differential cross sections computed for each molecular orbital channel, which should prove useful for MC-TS simulations.