Baseline Activities Research Articles

Microfluidics for hydrodynamic investigations of sand dollar larvae

The life cycle of most marine invertebrates includes a planktonic larval stage before metamorphosis to bottom-dwelling adulthood. During the larval stage, ciliary-mediated activity enables feeding (capturing unicellular algae) and transporting materials (e.g., oxygen) required for the larva’s growth, development, and successful metamorphosis. Investigating the underlying hydrodynamics of the ciliary activities is valuable for addressing fundamental biological questions (e.g., phenotypic plasticity) and advancing engineering applications (e.g., biomimetic design). We combined microfluidics and fluorescence microscopy as a miniaturized particle image velocimetry approach to study ciliary-mediated hydrodynamics during suspension feeding in sand dollar larvae (Dendraster excentricus). First, feasibility was confirmed by examining the underlying hydrodynamics (ciliary-mediated vortex patterns) for low- and high-fed larvae. Next, ciliary hydrodynamics were tracked from 11 days post-fertilization (DPF) to 20 DPF for 21 low-fed larvae. Microfluidics enabled the examination of baseline activities (without external flow) and behaviors in the presence of environmental cues (external flow). A library of qualitative vortex patterns and quantitative hydrodynamics (velocity and vorticity profiles) was generated. Velocities were used to examine the role of ciliary activity in transporting materials. Given the laminar flow and the viscosity-dominated environments surrounding the larvae, overcoming the diffusive boundary layer is critical. Péclet number analysis for oxygen transport suggested that ciliary velocities help overcome the diffusion-dominated transport. The approach was used to examine the hydrodynamics of two additional marine larvae (P. helianthoides and S. purpuratus). Microfluidics provided a scalable and accessible approach for investigating the ciliary hydrodynamics of marine organisms.

Feasibility of a Multimodal Prehabilitation Program Before Elective Knee and Hip Arthroplasty in Older Adults

ObjectivesHip osteoarthritis and knee osteoarthritis cause significant disability and pain in older adults, often leading to hip or knee replacement surgery. Prehabilitation programs have been established for these surgeries, but there are few programs for orthogeriatrics. We evaluated the feasibility of a new multimodal prehabilitation program (MPP) for older adults before hip or knee replacement due to arthrosis: the Prehabilitation for Os (PRE4OS) study. DesignWe conducted a multicenter feasibility study in the Greater Paris area. Setting and ParticipantsEligible adults were ≥75 years old awaiting hip or knee replacement with at least a 6-week delay before surgery and able to participate in the MPP follow-up. The MPP included weekly hospital sessions providing nutritional, psychological, functional, and cognitive support, along with weekly home sessions featuring physiotherapist visits. MethodsThe primary outcome was at least 80% of 1-day hospital (ODH) sessions performed by 80% of participants. Secondary outcomes included intervention achievement, quality of life, and nutritional and functional status changes. Participant's satisfaction was qualitatively assessed via structured phone interviews presurgery and at 30 days postsurgery. ResultsFrom September 2021 to September 2023, a total of 27 individuals participated in the PRE4OS study. The mean (SD) age was 83 (4.3) years, with 7 males (26%) and median baseline Activities of Daily Living score 5.5 (interquartile range 5.5–6.0). Surgeries were for insertion of hip prosthesis in 17 participants (63%) and knee prosthesis in 10 (37%). The primary outcome was achieved in 89% of participants, with comparable rates for hip and knee prostheses. In total, 60% of participants rated the MPP as “excellent” presurgery and 100% at 30 days postsurgery, expressing a willingness to recommend the protocol to a friend or family. Conclusion and ImplicationsThe MPP was feasible for individuals before hip or knee replacement and was well received. Further randomized trials are needed to assess its clinical impact.

Sheng Zhen Gong in pregnancy: The effects of a traditional low intensity exercise form on maternofetal health and wellbeing

Objective: The aim of the study was to evaluate maternal and fetal responses to Sheng Zhen Gong (SZG), a low intensity form of exercise, using multi-modal antenatal surveillance techniques. Methods: This was a single-blinded randomized controlled trial in low risk pregnant women from a tertiary center in the Philippines. Participants were randomized into Chronic Exercise (CE), Acute Exercise (AE) and No Exercise (NE) groups. A Pregnancy Physical Activity Questionnaire (PPAQ) was given to ascertain baseline activities. Systematic periodic assessment was performed utilizing standard ultrasound and Doppler studies between 20+0 to 32+0 weeks gestation with or without sessions involving a biophysical and Warwick-Edinburgh Mental Well-being Scale (WEMWBS) evaluation before and after SZG exercise. Results: Eighty-nine (89) women were included with average energy expenditures of light to moderate intensity. In the CE group, systolic, diastolic, mean arterial pressures and heart rates were lower while oxygen saturations increased after exercise (n=35; p: <0.01 to 0.01). There were also observable significant increases in maternal well-being scores after exercise for both CE (n=35) and AE (n=21) groups (p<0.01). Increasing the frequency of exercise was also associated with better maternal well-being (p: 0.02). Fetal Doppler studies showed no significant changes after exercise. Conclusion: In normal pregnancy, routine low intensity physical activity in the form of SZG was seen to have positive effects on maternal cardiovascular, blood glucose and mental well-being maintenance with no evidence of detrimental effects on the fetus.

A NOVEL METHOD FOR THE ANALYSIS OF RENAL SYMPATHETIC NERVE ACTIVITY FROM MULTI-FIBER NERVE RECORDINGS

Objective: Measurement of renal sympathetic nerve activity (RSNA) via bipolar electrodes from multi-fiber preparations in various species has been used for decades in the context of autonomic regulation research. Traditionally, raw neurograms are usually integrated over short time intervals and this approach works perfectly for the analysis of dynamic RSNA changes due to acute intervention. However, comparability of baseline activities between groups is limited. We present a novel analysis method, based on the raw neurogram sampled at rate of 25 kHz. Design and method: For RSNA-burst analysis a software based programmable algorithm was used. Continuous activities longer than three single spikes (i.e., >8ms) were defined as bursts, followed by silent periods with some single spikes. Approximately 10.000 bursts/rat were analyzed and burst amplitude, burst duration, burst area (i.e., duration integral), as well as the burst frequencies were analyzed. Results: In rats with myocardial infarction (n=11) we found no difference in integrated baseline RSNA as compared to controls ((n=10). However, the new method revealed higher higher burst rate per cardiac cycle [CC] (2.65 ± 0.39 vs. 1.61 ± 0.38 bursts/CC; P<0.001) and burst frequency (15.09 ± 2.42 vs. 8.52 ±1.54 Hz; P<0.001) compared to healthy controls, indicating increased RSNA. Conclusions: Our new method of RSNA baseline analysis was able to detect subtle differences between groups of animals that could not be detected by the traditional method of integrated RSNA analysis. Furthermore, this method has the potential to give further insights into RNSA patterns and synchronization to afferent regulatory input form the kidney itself or other organs.

A Mathematical Model of Spontaneous Action Potential Based on Stochastics Synaptic Noise Dynamics in Non-Neural Cells

We developed a mathematical model to simulate the dynamics of background synaptic noise in non-neuronal cells. By employing the stochastic Ornstein–Uhlenbeck process, we represented excitatory synaptic conductance and integrated it into a whole-cell model to generate spontaneous and evoke cellular electrical activities. This single-cell model encompasses numerous biophysically detailed ion channels, depicted by a set of ordinary differential equations in Hodgkin–Huxley and Markov formalisms. Consequently, this approach effectively induced irregular spontaneous depolarizations (SDs) and spontaneous action potentials (sAPs), resembling electrical activity observed in vitro. The input resistance decreased significantly, while the firing rate of spontaneous action potentials increased. Moreover, alterations in the ability to reach the action potential threshold were observed. Background synaptic activity can modify the input/output characteristics of non-neuronal excitatory cells. Hence, suppressing these baseline activities could aid in identifying new pharmaceutical targets for various clinical diseases.

Associations between Baseline Hyponatremia and Activities of Daily Living and Muscle Health in Convalescent Stroke Patients.

Evidence is scarce regarding the association between hyponatremia and functional outcomes among older hospitalized patients. We aimed to evaluate the associations between baseline hyponatremia and improvement in activities of daily living (ADL) and muscle health in hospitalized post-stroke patients. This retrospective cohort study included hospitalized post-stroke patients. Serum sodium concentrations were extracted from medical records based on blood tests performed within 24 h of admission, with hyponatremia defined as a serum sodium concentration below135 mEq/L. Primary outcome was the discharge ADL as assessed by the motor domain of the Functional Independence Measure (FIM-motor) and its corresponding gain during hospitalization. Other outcomes encompassed the discharge scores for skeletal muscle mass (SMI) and handgrip strength (HGS). Multivariate linear regression analyses were used to determine the association between hyponatremia and outcomes of interest, adjusted for potential confounders. Data from 955 patients (mean age 73.2 years; 53.6% men) were analyzed. The median baseline blood sodium level was 139 [interquartile range: 137, 141] mEq/L, and 84 patients (8.8%) exhibited hyponatremia. After full adjustment for confounders, baseline hyponatremia was significantly and negatively associated with FIM-motor at discharge (β=-0.036, P=0.033) and its gain during hospital stay (β=-0.051, P=0.033). Baseline hyponatremia exhibited an independent and negative association with discharge HGS (β=-0.031, P=0.027), whereas no significant association was found between baseline hyponatremia and discharge SMI (β=-0.015, P=0.244). Baseline hyponatremia demonstrated a correlation with compromised ADL and muscle health in individuals undergoing rehabilitation after stroke.

Abstract P410: A Novel Method For The Analysis Of Renal Sympathetic Nerve Activity From Multi-fiber Nerve Recordings

Introduction: Measurement of renal sympathetic nerve activity (RSNA) via bipolar electrodes from multi-fiber preparations in various species has been used for decades in the context of autonomic regulation research. Traditionally, raw neurograms are usually integrated over short time intervals and this approach works perfectly for the analysis of dynamic RSNA changes due to acute intervention. However, comparability of baseline activities between groups is limited. We present a novel analysis method, based on the raw neurogram sampled at rate of 25 kHz. Material and methods: For RSNA-burst analysis a software based programmable algorithm was used. Continuous activities longer than three single spikes (i.e., >8ms) were defined as bursts, followed by silent periods with some single spikes. Approximately 10.000 bursts/rat were analyzed and burst amplitude, burst duration, burst area (i.e., duration integral), as well as the burst frequencies were analyzed. Results: In rats with myocardial infarction (n=11) we found no difference in integrated baseline RSNA as compared to controls ((n=10). However, the new method revealed higher higher burst rate per cardiac cycle [CC] (2.65 ± 0.39 vs. 1.61 ± 0.38 bursts/CC; P<0.001) and burst frequency (15.09 ± 2.42 vs. 8.52 ±1.54 Hz; P<0.001) compared to healthy controls, indicating increased RSNA. Conclusion: Our new method of RSNA baseline analysis was able to detect subtle differences between groups of animals that could not be detected by the traditional method of integrated RSNA analysis. Furthermore, this method has the potential to give further insights into RNSA patterns and synchronization to afferent regulatory input form the kidney itself or other organs.

Non-steroidal Anti-inflammatory Drugs and Osteopathic Manipulative Treatment for Pain Management in Patients With Osteoarthritis: A Literature Review.

The pathophysiology of osteoarthritis (OA) involves the destruction of articular cartilage and the overgrowth of bone with lipping and spur formation. Nerve endings in the joint capsule and adjacent tissues play a major role in the pain mechanisms of osteoarthritis. This often requires patients to seek pain control measures beyond over-the-counter drugs, such as local anesthetics. Osteopathic manipulation treatment (OMT) is a conservative, non-pharmacological treatment that can be used to help treat chronic pain associated with OA. Other non-pharmacologic therapies include weight loss, exercise, physical therapy (PT), and assistive devices. However, pharmacologic management may be added synergistically to control flares and maintain baseline activities of daily living. While oral non-steroidal anti-inflammatory drugs (NSAIDs) have been the mainstay of treatment for pain and inflammation associated with OA, they have a non-selective inhibitory action that often results in negative side effects when used chronically. The possibility of minimizing these complications through alternate treatments such as topical NSAIDs provides an opportunity for patients to receive adequate pain relief from OA without suffering unnecessary consequences. This literature review seeks to assess the state of research regarding topical NSAIDs and OMT as alternatives to the current gold-standard treatment of OA. The significant inclusion criteria consisted of articles that described the effects of OMT on OA or the use of topical NSAIDs such as Voltaren on OA. Due to the limited articles found, a qualitative analysis was performed, and the salient conclusions are outlined. Alternative pharmacological and non-pharmacological treatments, such as topical diclofenac gel and OMT, have shown promising results in the treatment of pain in OA. It is seen that a majority of patients achieve pain management using NSAIDs, acetaminophen, or topical analgesics. Both diclofenac sodium and OMT have individually been shown to be effective treatments of OA when compared to the use of oral NSAIDs. A holistic treatment approach that utilizes both topical diclofenac sodium and OMT may provide OA patients with an effective option to reduce their moderate to severe chronic pain with limited side effects. Further, high-quality randomized controlled trials are needed to identify whether synergistic effects occur when combining diclofenac sodium gel and OMT for pain relief in patients with OA.

Management of a Complex Case of a Recurrent Paraganglioma.

Paragangliomas are rare, slow-growing, hypervascular, catecholamine-secreting neuroendocrine tumors arising from the paraganglia. Paragangliomas are rarely found in the head and neck and are typically benign, presenting as a painless, slow-growing mass. Surgical extirpation in combination with long-term surveillance has been long regarded as the standard of care; however, the advances in imaging, radiation therapy, and embolization techniques have improved diagnostic and therapeutic modalities. We present a case of an 87-year-old female who had previously undergone resection of a paraganglioma in 1998, with no evidence of disease in 2002. Eighteen years later, the patient presented to the clinic with otogenic complaints. Imaging showed an expansive mass from the jugular foramen with bone destruction and opacification within the ear canal. The patient opted for observation. The patient eventually presented to the emergency room with neurologic manifestations. Imaging showed a cerebellar abscess prompting emergency drainage. Intraoperative cultures grew Prevotella loescheii and S. intermedius, and the patient was started on 6 weeks of IV antibiotic therapy. Debulking of the paraganglioma was performed followed several months by mastoid and ear canal obliteration; however, the patient experienced complications, including dehiscence of the external auditory canal and Clostridium difficile infection. The patient was eventually treated successfully, marked by a reduction in complaints, a return to baseline activities, and imaging showing no increase in tumor size.

Incident sarcopenia in hospitalized older people: A systematic review.

Hospitalization has been associated with the development of sarcopenia. This study aimed to examine the new incidences of hospital sarcopenia, associated risk factors and health outcomes, as defined by internationally recognized diagnostic criteria in hospitalized older people. Pre-defined search terms were run through five databases. Six studies that assessed sarcopenia on two separate time points during hospitalization on older inpatients were included. Prevalence of sarcopenia varied from 14.1% to 55% depending on diagnostic criteria and cut-off points used. New sarcopenia occurred between 12% to 38.7% patients following hospitalization. Risk factors were older age, longer duration of bed rest, lower baseline body mass index, cognitive impairment and activities of daily living disability. None of the studies reported health outcomes associated with newly developed sarcopenia in hospital.

Cervical laminoplasty versus laminectomy and posterior cervical fusion for cervical myelopathy: propensity-matched analysis of 24-month outcomes from the Quality Outcomes Database.

Compared with laminectomy with posterior cervical fusion (PCF), cervical laminoplasty (CL) may result in different outcomes for those operated on for cervical spondylotic myelopathy (CSM). The aim of this study was to compare 24-month patient-reported outcomes (PROs) for laminoplasty versus PCF by using the Quality Outcomes Database (QOD) CSM data set. This was a retrospective study using an augmented data set from the prospectively collected QOD Registry Cervical Module. Patients undergoing laminoplasty or PCF for CSM were included. Using the nearest-neighbor method, the authors performed 1:1 propensity matching based on age, operated levels, and baseline modified Japanese Orthopaedic Association (mJOA) and visual analog scale (VAS) neck pain scores. The 24-month PROs, i.e., mJOA, Neck Disability Index (NDI), VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and North American Spine Society (NASS) satisfaction scores, were compared. Only cases in the subaxial cervical region were included; those that crossed the cervicothoracic junction were excluded. From the 1141 patients included in the QOD CSM data set who underwent anterior or posterior surgery for cervical myelopathy, 946 (82.9%) had 24 months of follow-up. Of these, 43 patients who underwent laminoplasty and 191 who underwent PCF met the inclusion criteria. After matching, the groups were similar for baseline characteristics, including operative levels (CL group: 4.0 ± 0.9 vs PCF group: 4.2 ± 1.1, p = 0.337) and baseline PROs (p > 0.05), except for a higher percentage involved in activities outside the home in the CL group (95.3% vs 81.4%, p = 0.044). The 24-month follow-up for the matched cohorts was similar (CL group: 88.4% vs PCF group: 83.7%, p = 0.534). Patients undergoing laminoplasty had significantly lower estimated blood loss (99.3 ± 91.7 mL vs 186.7 ± 142.7 mL, p = 0.003), decreased length of stay (3.0 ± 1.6 days vs 4.5 ± 3.3 days, p = 0.012), and a higher rate of routine discharge (88.4% vs 62.8%, p = 0.006). The CL cohort also demonstrated a higher rate of return to activities (47.2% vs 21.2%, p = 0.023) after 3 months. Laminoplasty was associated with a larger improvement in 24-month NDI score (-19.6 ± 18.9 vs -9.1 ± 21.9, p = 0.031). Otherwise, there were no 3- or 24-month differences in mJOA, mean NDI, VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and distribution of NASS satisfaction scores (p > 0.05) between the cohorts. Compared with PCF, laminoplasty was associated with decreased blood loss, decreased length of hospitalization, and higher rates of home discharge. At 3 months, laminoplasty was associated with a higher rate of return to baseline activities. At 24 months, laminoplasty was associated with greater improvements in neck disability. Otherwise, laminoplasty and PCF shared similar outcomes for functional status, pain, quality of life, and satisfaction. Laminoplasty and PCF achieved similar neck pain scores, suggesting that moderate preoperative neck pain may not necessarily be a contraindication for laminoplasty.

Fibula Stress Fractures: A Systematic Review.

Fibula stress fractures are moderately common injuries among athletes and military recruits. Most of the available data for treatment come from case reports with a limited number of large studies. This systematic review aims to evaluate and present the current literature on fibula stress fractures to help set evidence-based goals and establish realistic expectations for return to activity and sport in injured patients. Systematic literature search using 3 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. The terms "fibula stress fracture" or "fibular stress fracture" were searched. Date range for inclusion was 2010-2022. Pediatric, non-English, lack of full text available, and studies lacking differentiating fibula stress fracture versus other types of fractures in their data were excluded. A total of 3 studies with 10 987 subjects were included. Among 521 stress fractures in all 3 studies, there were 45 (8.6% of all fractures) cases involving the fibula. All fibular stress fractures healed successfully with nonoperative measures and non-weight-bearing precautions, on average, by 7 weeks and patients resumed activity, on average, by 9 weeks. Among the 3 studies, there were no reported cases of nonunion or delayed union. This review found that fibula stress fractures have a relatively moderate incidence among stress fracture injuries with a frequency up to 8.6%. Despite this high number, there is sufficient healing in fibula stress fractures when managed nonoperatively with activity modification in a weight-bearing foot to allow for resumption of baseline activities, on average, by 9 weeks. This review can be used to help set evidence-based goals and establish realistic expectations for return to activity and sport in patients who suffer from fibula stress fractures. Level II.

Successful Treatment of Wounds from Nonuremic Calciphylaxis with Acellular Piscine Dermis

Summary: In this report, we present a 57-year-old man with chronic bilateral lower extremity wounds from nonuremic calciphylaxis, which were successfully reconstructed using a piscine-derived acellular dermal matrix. The acellular dermal matrix incorporated quickly, providing a wound bed that was amenable to skin grafting. We demonstrate that this is an effective off-the-shelf solution for these chronic wounds, resulting in pain reduction and complete closure of the wounds, allowing the patient to return to his previous baseline activities, and improving his quality of life.

The spatiotemporal variation, background, and baseline activities of radionuclides in the soil of Aragats Massif (Armenia).

The present study was performed to reveal the distribution patterns and spatiotemporal changes of radionuclides in the soil of the highest mountain of Armenia: Aragats Massif. In this regard, two surveys were implemented in 2016-2018 and 2021 with an altitudinal sampling strategy. The activities of radionuclides were determined by gamma spectrometry system with HPGe detector (CANBERRA). Correlation and linear regression analysis were applied to determine the dependence of radionuclides' distribution from altitude. Classical and robust statistical methods were used to assess the local background and baseline values. In two sampling profiles, the spatiotemporal variation of radionuclides was studied. A significant correlation was revealed between 137Cs and altitude pointing to global atmospheric migration as a primary source of 137Cs in Armenian environment. The predicted values of regression model revealed a 0.08-Bq/kg and 0.03-Bq/kg increase of 137Cs in each m on average, for the old and new survey, respectively. The assessment of background activities of NOR (naturally occurring radionuclides) enables setting the local background for 226Ra, 232Th, and 40K in soils of Aragats Massif: 831.3 ± 20.2Bq/kg and 540.6 ± 18.3Bq/kg for 40K, 85.5 ± 3.1Bq/kg and 27.7 ± 2.6Bq/kg for 226Ra, and 66.8 ± 3.2 and 46.4 ± 3.0Bq/kg for 232Th, respectively, for the years of 2016-2018 and 2021. 137Cs baseline activity was estimated by altitude: 350 ± 3.7Bq/kg and 108 ± 2.5Bq/kg, respectively, for the years of 2016-2018 and 2021.

The Role of the Complement Pathway in Clinical Progression of Geographic Atrophy: Analysis of the Phase III Chroma and Spectri Trials

To investigate the relationship between complement pathway activities and progression of geographic atrophy (GA) secondary to age-related macular degeneration in samples collected from patients enrolled in the Chroma and Spectri trials. Chroma and Spectri were phase III, double-masked, and sham-controlled, 96-week trials. Aqueous humor (AH) samples collected at baseline and week 24 visits from 81 patients with bilateral GA across all 3 treatment groups (intravitreal lampalizumab 10 mg every 6 weeks, every 4 weeks, or corresponding sham procedures) were tested, along with patient-matched plasma samples collected at baseline. Antibody capture assays using the Simoa platform were used to measure the levels of complement factor B, the Bb fragment of complement factor B, intact complement component 3 (C3), processed C3, intact complement C4, and processed C4. Complement factor D levels were measured using enzyme-linked immunosorbent assay. Correlations of complement levels and activities (i.e., processed:intact ratio of complement component) in AH and plasma with baseline GA lesion size and growth rate. In baseline AH, there were strong correlations (Spearman's rho ≥ 0.80) between intact complement proteins, between processed complement proteins, and between linked processed and intact complement proteins; weak correlations (rho ≤ 0.24) were found between complement pathway activities. There were no strong correlations between complement protein levels and activities measured in AH and plasma at baseline (rho ≤ 0.37). Baseline complement levels and activities in AH and plasma did not correlate with baseline GA lesion size or change from baseline in GA lesion area at week 48 (i.e., annualized growth rate). There were no strong correlations between changes in complement levels/activities in the AH from baseline to week 24 and annualized GA lesion growth rate. Genotype analysis did not reveal a meaningful correlation between complement-related, age-related macular degeneration risk single-nucleotide polymorphisms and complement levels and activities. Complement levels or activities in AH and plasma did not correlate with GA lesion size or growth rate. This suggests that local complement activation as measured in AH does not appear to be related to GA lesion progression. Proprietary or commercial disclosure may be found after the references.

The Association between Masticatory Muscles Activation and Foot Pressure Distribution in Older Female Adults: A Cross-Sectional Study

The association between craniofacial muscles and postural control is well-known because of numerous anatomical connections. However, there are a few conflicting studies that correlated the activity of the masticatory muscles with the distribution of body weight pressure on the feet, which can strongly influence balance. Therefore, the purpose of our study was to evaluate the association between the masseter and temporalis muscle activity and foot pressure distribution. Fifty-two women were recruited, and baropodometric and EMG analyses of the masseter and temporalis baseline activities were analyzed. An ipsilateral association was found between the right temporal muscle activity and the right rearfoot load (r = 0.29, p < 0.05) and right forefoot load (r = -0.29; p < 0.05), as well as the percentage of muscle activation of the right masseter muscles with the percentage of pressure on the right forefoot (r = 0.31, p < 0.05) and right rearfoot (r = -0.31, p < 0.05). While further studies are needed, an ipsilateral association was found between masticatory muscles and foot pressure distribution.

Hybrid Percutaneous Management of Acute Midsubstance Achilles Tendon Ruptures

Background: Operative management techniques of Achilles tendon ruptures can be categorized into open repair, mini-open repair, or percutaneous repair. Indications: Surgical repair of acute ruptures of the Achilles tendon is indicated in athletic populations, with percutaneous repair being an effective technique with more favorable outcomes. Technique: With the patient prone, the Achilles rupture is identified and the Percutaneous Achilles Repair System (PARS) jig is inserted under the proximal paratenon. A series of Keith needles and flat braided SutureTape sutures are passed transversely across the proximal stump of the tendon. The sutures are then shuttled through the distal stump using a SutureLasso through medial and lateral percutaneous incisions on the distal medial and distal lateral borders of Achilles, respectively. Sutures are passed, tensioned, and secured to the posterior tuberosity of the calcaneus with two SwiveLock anchors. Results: Percutaneous repair, compared with open repair, results in lower wound complication rates, improved cosmetic appearance and fewer adhesions. Following surgery, patients follow a 5-stage rehabilitation protocol with return to sport when patients demonstrate dynamic neuromuscular control during multiplane activities without pain or swelling. Outcome studies have compared percutaneous repairs to open repairs, with percutaneous repairs demonstrating a quicker return to work or baseline activities (2.8 months versus 5.6 months) and a shorter return to play for athletes (average 18 weeks). Also, a greater number of PARS patients were able to return to baseline activities within 5 months (98%), compared with open repair patients (82%; P = .0001). In a prospective randomized controlled trial of 33 patients, Lim et al reported no postoperative wound infections in the percutaneous group and a 21% infection rate in the open repair group ( P = .01). Finally, in a recent systematic review of only percutaneous repairs, reported rates of sural nerve injury and rerupture were only 3.3% and 2.1%, respectively. Discussion/Conclusion: Compared to open repair, percutaneous Achilles repair allows for decreased risk of soft-tissue complications with comparable functional outcomes and earlier return to activity. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Direct Carotid Artery Cutdown and flow diversions for the bilateral Internal Carotid Artery Dissecting Pseudoaneurysms: A Case Report

Background: Surpass streamline flow diversion is performed by transfemoral, transradial or both approaches. Safety and feasibility of direct carotid artery cutdown and is not known. Objective is to report Surpass streamline flow diversion via direct carotid artery utdown for a patient with bilateral internal carotid artery dissecting pseudoaneurysm. Method: Case report. Outcome was measured using modified ranking scale (mRS). Results: Sixty-seven-year-old man with history of repaired aortic arch dissecting aneurysm using aortic stent, developed worsening headaches and dizziness and diagnosed with bilateral internal carotid artery dissecting pseudoaneurysm on a computed tomographic angiography; right internal carotid artery dissecting pseudoaneurysm measured 19x15x20 mm and left was 16x9x22 mm. Digital subtraction angiogram was attempted but failed. A direct carotid artery cutdown followed by surpass streamline flow diversion was performed in a staged fashion. A 6-french sheath was placed from right common carotid artery to right internal carotid artery by a vascular surgeon and was confined with digital subtraction angiography. An intermediate catheter was navigated to the internal carotid artery beyond the internal carotid artery dissecting pseudoaneurysm and surpass streamline flow diversion was achieved with 3 devices; 4x50 mm x2 and 5x40 mm. Carotid artery cutdown site was sutured by vascular surgeon. Patient was extubated and discharged home in 48 hours with NIHSS 0 and mRS1 at his baseline. The left internal carotid artery dissecting pseudoaneurysm was repaired after 3 month using similar technique as described above with two 5x50 mm flow diverters. For the second procedure, angioplasties were required for better appositions of flow diverters. Patient was discharged home in 24 hours. Patient’s symptoms resolved and resumed baseline activities. Prescribed to continued 325 mg aspirin and 75 mg clopidogrel for six months followed by 162 mg aspirin and 75 mg of clopidogrel. Patient maintained mRS 0 in follow-up visits but refused to have a computed tomographic angiography, which finally performed in 24 months, demonstrates complete obligations of the left internal carotid artery dissecting pseudoaneurysm but occlusion of right internal carotid artery with robust collaterals from left internal carotid artery through collaterals. Patient admits premature discontinuation of antiplatelets when he learned about his computed tomographic angiography results. Conclusion: This is the first report of treatment of bilateral internal carotid artery dissecting pseudoaneurysm repaired by direct carotid artery cutdown approach. This is also the first report of a patient with an aortic arch stent, who developed bilateral internal carotid artery dissecting pseudoaneurysm and direct carotid artery cutdown required for treatment. Additionally, antiplatelets must be continued to prevent device occlusion.

Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better?

The aim of this study was to determine whether multilevel anterior cervical discectomy and fusion (ACDF) or posterior cervical laminectomy and fusion (PCLF) is superior for patients with cervical spondylotic myelopathy (CSM) and high preoperative neck pain. This was a retrospective study of prospectively collected data using the Quality Outcomes Database (QOD) CSM module. Patients who received a subaxial fusion of 3 or 4 segments and had a visual analog scale (VAS) neck pain score of 7 or greater at baseline were included. The 3-, 12-, and 24-month outcomes were compared for patients undergoing ACDF with those undergoing PCLF. Overall, 1141 patients with CSM were included in the database. Of these, 495 (43.4%) presented with severe neck pain (VAS score > 6). After applying inclusion and exclusion criteria, we compared 65 patients (54.6%) undergoing 3- and 4-level ACDF and 54 patients (45.4%) undergoing 3- and 4-level PCLF. Patients undergoing ACDF had worse Neck Disability Index scores at baseline (52.5 ± 15.9 vs 45.9 ± 16.8, p = 0.03) but similar neck pain (p > 0.05). Otherwise, the groups were well matched for the remaining baseline patient-reported outcomes. The rates of 24-month follow-up for ACDF and PCLF were similar (86.2% and 83.3%, respectively). At the 24-month follow-up, both groups demonstrated mean improvements in all outcomes, including neck pain (p < 0.05). In multivariable analyses, there was no significant difference in the degree of neck pain change, rate of neck pain improvement, rate of pain-free achievement, and rate of reaching minimal clinically important difference (MCID) in neck pain between the two groups (adjusted p > 0.05). However, ACDF was associated with a higher 24-month modified Japanese Orthopaedic Association scale (mJOA) score (β = 1.5 [95% CI 0.5-2.6], adjusted p = 0.01), higher EQ-5D score (β = 0.1 [95% CI 0.01-0.2], adjusted p = 0.04), and higher likelihood for return to baseline activities (OR 1.2 [95% CI 1.1-1.4], adjusted p = 0.002). Severe neck pain is prevalent among patients undergoing surgery for CSM, affecting more than 40% of patients. Both ACDF and PCLF achieved comparable postoperative neck pain improvement 3, 12, and 24 months following 3- or 4-segment surgery for patients with CSM and severe neck pain. However, multilevel ACDF was associated with superior functional status, quality of life, and return to baseline activities at 24 months in multivariable adjusted analyses.

Impact of workflow interruptions on baseline activities of the doctors working in the emergency department

BackgroundWorkflow interruptions are common in the emergency department (ED) of the hospitals for physicians, leading to an increased risk of errors.PurposeThis study aims to understand the baseline activities of the...