Delay In Recovery Research Articles

Impact of Insurance Status on Postoperative Recovery After Microsurgical Breast Reconstruction.

Persistent disparities in breast reconstruction access have been widely documented, yet a significant research gap remains in understanding the impact of social determinants of health (SDOH) on postoperative outcomes and complications. A retrospective chart review was performed on all patients who underwent abdominal-based free-flap breast reconstruction between August 2018 and December 2022 at a racially, ethnically, and socioeconomically diverse urban academic institute with a historically underserved patient population. Patients were stratified by the public (Medicare and Medicaid) versus private insurance as a proxy for SDOH. Patient demographics, length of stay (LOS), timing in progression through postoperative recovery milestones, and complications were compared. A total of 162 patients were included, and 57% of patients had public insurance, with this group more likely to be Hispanic (OR2.7; p=0.003) and Spanish-speaking (OR3.4; p=0.003). Privately insured patients were more likely to be non-Hispanic black (OR2.7; p=0.006). Patients with public insurance had a higher rate of unplanned return to the operating room within 90 days and a higher incidence of complications, though not statistically significant. They also experienced a significantly longer LOS than privately insured patients (3.6±1.0 days vs 3.0±0.7 days; p<0.0001). Logistic regression identified a LOS exceeding 3 days as independently associated with public insurance status (OR3.0; p=0.03), bilateral procedure (OR5.6; p=0.0007), preoperative functional-dependent status (OR7.0; p=0.04), and higher BMI (OR1.1; p=0.03). Patients with public insurance were more likely to encounter delays in achieving recovery milestones. Public insurance status, serving as a proxy for a disadvantage in SDOH, is predictive of extended LOS and postoperative recovery delays following microsurgical breast reconstruction. This underscores the need for future quality improvement efforts to address and mitigate these disparities.

Increased neutrophil extracellular traps caused by diet-induced obesity delay fracture healing.

Obesity, recognized as a risk factor for nonunion, detrimentally impacts bone health, with significant physical and economic repercussions for affected individuals. Nevertheless, the precise pathomechanisms by which obesity impairs fracture healing remain insufficiently understood. Multiple studies have identified neutrophil granulocytes as key players in the systemic immune response, being the predominant immune cells in early fracture hematomas. This study identified a previously unreported critical period for neutrophil infiltration into the callus. Invivo experiments demonstrated that diet-induced obesity (DIO) mice showed earlier neutrophil infiltration, along with increased formation of neutrophil extracellular traps (NETs), compared to control mice during the endochondral phase of fracture repair. Furthermore, Padi4 knockout was found to reduce NET formation and mitigate the fracture healing delays caused by high-fat diets. Mechanistically, invitro analyses revealed that NETs, by activating NLRP3 inflammasomes, inhibited the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) and concurrently promoted M1-like macrophage polarization. These findings establish a connection between NET formation during the endochondral phase and delayed fracture healing, suggesting that targeting NETs could serve as a promising therapeutic approach for addressing obesity-induced delays in fracture recovery.

Ultrafast T1-T1ρ NMR for Correlating Different Motional Regimes of Molecules.

Nuclear magnetic resonance (NMR) relaxation times provide detailed information about molecular motions and local chemical environments. Longitudinal T1 relaxation time is most often sensitive to relatively fast, nano- to picosecond ranges of molecular motion. Rotating frame T1ρ relaxation time reflects a much slower, micro- to millisecond range of motion, and the motional regime can be tuned by changing spin-lock field strength. Conventional methods for measuring T1 and T1ρ relaxation times are time-consuming, since experiments must be repeated many times with incremented magnetization recovery or decay delay. In this work, we introduce two novel and efficient NMR methods to correlate the T1 and T1ρ relaxation times. The first method, IR-SPICY, combines the conventional T1 inversion recovery (IR) with the single-scan T1ρ detection-based spin-lock cycle (SPICY). The second method, ultrafast (UF) IR-SPICY, allows measurement of whole two-dimensional T1-T1ρ correlation data in a single scan, in a couple of seconds, based on spatial encoding of the T1 dimension. We demonstrate the performance of the methods by studying relaxation of water in porous silica and hydrogel samples, latter acting as a model of the articular cartilage extracellular matrix. The methods allow correlating different molecular motional regimes, potentially providing unprecedented information about various chemical and biochemical systems, such as structures and fluid dynamics in porous materials, macromolecular changes in tissues, and protein dynamics. One to three orders of magnitude shortened experiment time enable the studies of changing or degrading samples. Furthermore, the single-scan approach may significantly facilitate the use of modern nuclear-spin hyperpolarization techniques to enhance the sensitivity of T1-T1ρ measurements by several orders of magnitude.

Age-Related Response to Remimazolam among Older Patients Undergoing Orthopedic Surgery: A Single-Center Prospective Observational Study

Background and Objectives: Remimazolam, an ultra-short-acting benzodiazepine, is increasingly used in procedural sedation and general anesthesia. It is characterized by rapid onset of action, inactive metabolites, no delay in recovery, and few adverse events. Its hemodynamic and respiratory stability are comparable to other anesthetics, and it is safe in high-risk and geriatric patients. Materials and Methods: This prospective, observational study enrolled 110 geriatric patients (aged 65 to 85 years) scheduled for primary total knee arthroplasty (TKA). The patients were divided into the old (65 to &lt;75 years; n = 52) and the elderly (75 to 85 years; n = 47) geriatric groups. All surgical and anesthetic methods were applied in the same manner, and TKA was performed by one surgeon. Remimazolam was infused at 6 mg/kg/h for 3 min and then at 1 mg/kg/h until the end of surgery The primary study endpoint was the requirement for flumazenil; secondary endpoints were the times to reach a bispectral index (BIS) &lt; 60 and &gt;80, as well as the rate of apnea occurrence. Results: Flumazenil administration was similar in both groups. There were no differences in the time to reach BIS &lt; 60 or the rate of apnea occurrence. Recovery characteristics, including the time to reach BIS &gt; 80 and the achievement of full consciousness, were also comparable between the groups. Conclusions: Remimazolam is well-tolerated in geriatric patients undergoing orthopedic surgery, with minimal age-related differences in response. These results suggest that remimazolam is an appropriate anesthetic for geriatric patients, even with similar dosing strategies. It provides effective anesthetic depth with no significant increases in adverse outcomes during orthopedic surgery.

An investigation on stabilisation and phase transformation characteristics of Cu-Al-Be shape-memory alloys quenched in different media

ABSTRACT The aim of the present investigation is to fabricate the ternary Cu87.59, Al11.99 and Be0.42 (wt.%) shape memory alloy (SMA), and to study the effect of quenching medium on the phases, phase transformation, stabilisation, and shape recovery ratio. SMA was fabricated, betatized at high temperature (β) and then quenched into different media and quench types. The quenched SMAs are examined for phases, microstructure, phase transformation temperatures, martensite stabilisation and shape recovery ratio. XRD results reveal that all the quenched alloys are of complete martensite of 18 R and 2 H variants. Meta quench oil quenched SMAs possess pure martensite, smaller grain size, lower transformation temperatures, and rapid recovery, whereas silicone oil exhibits larger grain size and delay in recovery and the mechanisms are discussed in detail in the discussion part. MQ oil quenched SMAs are suitable and recommended for rapid response/recovery actuator applications with enhanced properties.

Does dimenhydrinate delay recovery of vestibular ocular reflex in acute unilateral vestibulopathy? A retrospective comparative study

Does dimenhydrinate delay recovery of vestibular ocular reflex in acute unilateral vestibulopathy? A retrospective comparative study

Venetoclax Combined With FLAG-IDA in Refractory or Relapsed Acute Myeloid Leukemia.

The prognosis of patients with refractory or relapsed AML (R/R-AML) is very limited. To (re)achieve complete remission, there has recently been increasing evidence that the combination of venetoclax (VEN) with chemotherapy is associated with improved outcomes. Our retrospective, single-center study of 53 R/R-AML patients with a median follow-up time of 11.0 months compared standard salvage chemotherapy (FLAG-Ida or HAM in n = 35 patients) with a combination of venetoclax (VEN) and FLAG-Ida (FLAVIDA in n = 18 patients) concerning safety and efficacy. Regarding the primary endpoints, there was a statistically significant increased eventfree survival (EFS) in the FLAVIDA group compared to patients with standard chemotherapy based on the univariate log-rank-test and in the multivariate Cox regression analysis (HR 0.22 [95% CI 0.05, 0.97]). There were no differences between the two groups in terms of patients developing febrile neutropenia CTCAE III° and IV° or a delay in hematological recovery. In addition, a clear trend towards an improved overall response rate (78% vs. 51%) was demonstrated in the FLAVIDA group. The FLAVIDA regimen represents a promising treatment alternative for R/R AML patients with a high response rate and significantly improved EFS compared to standard chemotherapy.

The effects of different interruption conditions on mental workload: an experimental study based on multimodal measurements

Interruptions in the working environment cause extra mental workload for the operators, and this phenomenon has garnered significant research attention. This study designed four interruption conditions based on the perceptual and cognitive perspectives of human information processing, using a 2(perceptual primary task and cognitive primary task)*2(perceptual interruption task and cognitive interruption task) factorial design. Multimodal measurement methods were used to evaluate mental workload in different interruption conditions. The results show that when the primary task and the interruption task are different load types, they generate a higher mental workload than the same load type. It can be attributed to the fact that perceptual tasks and cognitive tasks increase mental workload during switching. In addition, based on the multimodal index data, the prediction model of interruption recovery delay time and the classification model of interruption conditions are established, which provides a basis for rational scheduling of work and preventing mental overload.

Reamputation Rate, Mortality, and the Incidence of Risk Factors for Ipsilateral Reamputation Among Patients with Dysvascular Major Lower Limb Amputation

A major lower-limb amputation (LLA) for dysvascular disease carries the risk of disturbed wound healing necessitating reamputation at a higher level. A reamputation causes a delay in prosthetic fitting and recovery of walking ability. The combination of a prolonged open wound and inability to walk can worsen of the physical and psychological situation. Prevention of reamputation seems therefore important. This study aims to identify risk factors for reamputation, and to evaluate a possible altered mortality rate after a dysvascular major LLA. These issues are crucial for shared decision-making prior to surgery. Retrospective study investigating a Dutch regional cohort of patients with a dysvascular below-knee, through-knee, or above-knee LLA. 516 Dysvascular major LLAs were included (2014-2018). One hundred reamputations were performed within 1 year after initial amputation (19.4%). Risk factors for ipsilateral reamputation were diabetes mellitus, lipid-lowering drugs usage, and lower level of amputation (respectively P = < 0.01, 0.037, and < 0.01). The 30-day mortality rates were 1% and 12% for the reamputation group and the non-reamputation group respectively (P = < 0.01). The 1-year mortality rates were 23% and 27% for the reamputation group and the non-reamputation group respectively (P = 0.423). Ipsilateral reamputation within one year after initial amputation is common. Several risk factors for reamputation were identified. The 30-day and 1-year mortality rate is high, but not significantly different after one year. A clinical decision tool for dysvascular patients needs to be developed to improve shared decision-making, reduce reamputation rates, and improve survival.

Hemodynamic Instability during Intermittent Hemodialysis in ICU Patients with Abnormal Capillary Refill Time

Intradialytic Hemodynamic Instability (IHI) may cause delay in renal recovery and also increases risk of mortality. Capillary Refill Time (CRT) was a stress free method used for peripheral perfusion that becomes worse during circulatory failure. Objective: To determine Hemodynamic Instability during Intermittent Hemodialysis in ICU Patients with Abnormal Capillary Refill Time at a tertiary care hospital, Karachi, Pakistan. Methods: This was the 06 months’ data collection, 1-year prospective observational study. Overall 137 patients were evaluated via sampling technique of non-probability consecutive sampling technique. For each intermittent hemodialysis session, index CRT was recorded. IHI was noted down 30 minutes before the beginning of intermittent hemodialysis and then 60 minutes, 120 minutes and 180 minutes. Entire data were recorded as a predesigned proforma. The natural distribution of patients into subgroups was done using Chi Square test considering p-value ≤0.05 as significant Results: The total population was 98 men (71.5%) and 39 women (28.5%) Average age was 61.51 ± 15.37 years. 45(17.5%) patients observed abnormal Capillary refill time. 20(14.6%) patients experienced intradialytic hemodynamic instability. Among patients diagnosed with intradialytic hemodynamic instability, 9(45%) had abnormal CRT. Compared to patients with normal CRT, individuals with aberrant CRT had a higher risk of hemodynamic instability (OR = 5.564, p &lt; 0.001). Conclusion: IHI was most at risk when it comes to initiating intermittent hemodialysis, especially in the first hour of the first session. The increase in index capillary refill time was linked to IHI.

Comparison of autonomic nervous system dysfunction, arterial stiffness, and heart rate recovery according to spinal cord injury level.

To investigate the differences in autonomic nervous system (ANS) dysfunction, arterial stiffness, and the degree of delay in post-exercise heart rate recovery (HRR) according to the level of spinal cord injury (SCI), and propose preventive measures against cardiovascular diseases after SCI. This retrospective study included 51 patients with SCI. Based on the neurological level of injury (NLI), patients were divided into two groups: Group A (NLI at and above T6) and Group B (NLI below T6). To assess ANS dysfunction, the head-up tilt test and 24-hour ambulatory blood pressure monitoring were conducted. Arterial stiffness was measured using the pulse wave velocity test. The exercise tolerance test was conducted to measure post-exercise HRR. Group A had significantly higher values in the head-up tilt test and 24-hour ambulatory blood pressure monitoring. In the pulse wave velocity test, both sides (left and right) had significantly higher values in Group B. One minute after the exercise tolerance test, Group A had significantly slower HRR (18.8 ± 11.1 beats/minute) than Group B. Understanding the impact of ANS dysfunction and arterial stiffness on HRR in SCI according to NLI may provide insights for clinical management and preventative strategies for cardiovascular diseases.

Study of consecutive eclipses of pulsar J0024-7204O

ABSTRACT The eclipses seen in the radio emission of some pulsars can be invaluable to study the properties of the material from the companion stripped away by the pulsar. We present a study of six consecutive eclipses of PSR J0024–7204O in the globular cluster 47 Tucanae as seen by the MeerKAT radio telescope in the UHF (544–1088 MHz) band. A high scintillation state boosted the signal during one of the orbits and allowed a detailed study of the eclipse properties. We measure significant dispersion measure (DM) variations and detect strong scattering that seems to be the dominating mechanism of the eclipses at these frequencies. A complete drop in the linear polarization together with a small increase in the rotation measure suggests the presence of a magnetic field of $\sim 2$ mG. The study of multiple eclipses allowed us to measure difference in the lengths of the eclipses and DM differences of $\sim 0.01$ pc cm$^{-3}$ in consecutive orbits. One orbit, in particular, shows a delay in recovery of the linear polarization and a visible delay in the arrival of the pulses caused by a stronger scattering event. We suggest that these are caused by a higher variance of density fluctuations during the event.

A framework of survivability model virtualized wireless sensor networks for IOT‐assisted wireless sensor network

AbstractUsing traditional non‐virtualized Wireless Sensor Networks (WSNs) efficiently is difficult due to the embedded applications, which make the sensor nodes inaccessible to other applications. The proposed study considered both the node‐level and network‐level virtualization of wireless sensor networks to examine dynamic virtual network embedding. WSNs can leverage their shared sensing capabilities through network virtualization. Infrastructure providers earn more revenue by mapping more virtual network embedding (VNE) onto their substrate networks. VNE must therefore improve its acceptance ratio. The proposed RLE‐SVNE is demonstrated to be more efficient than state‐of‐the‐art in respect to acceptance, recovery, failure recovery delay, and revenue cost through simulation results. It compares the RLF‐SVNE method with C‐SVNE and N‐SVNE to demonstrate its superiority.

Postexercise Oxygen Uptake Recovery Delay among Patients with Heart Failure: A Systematic Review

Postexercise Oxygen Uptake Recovery Delay among Patients with Heart Failure: A Systematic Review

Preoperative Sarcopenia Severity and Clinical Outcomes after Total Hip Arthroplasty.

The outcome of total hip arthroplasty (THA) in patients with end-stage arthritis of the hip is associated with preoperative physical status. This study was performed to examine the relationship between the preoperative severity of sarcopenia and clinical outcomes after THA. This retrospective cohort study was performed among 306 consecutive patients (mean age: 63.7 ± 12.9 years, 222 women) undergoing THA at a university hospital. The severity of sarcopenia was determined based on the skeletal muscle mass index (SMI), handgrip strength, and gait speed according to the criteria of the Asian Working Group for Sarcopenia 2019. The severe sarcopenia prevalence rate was 10.6%. Severe sarcopenia was significantly associated with the risk of delayed functional recovery (adjusted odds ratio, 2.82; 95% confidence interval, 1.03-7.72; p = 0.043) compared with the non-sarcopenia group after adjusting for pre-existing risk factors, including preoperative hip function and physical activity. The addition of SMI, handgrip strength, and gait speed to the model for risk of functional recovery delay significantly increased the area under the receiver operating characteristic curve (p = 0.038). Severe sarcopenia was significantly associated with poorer hip function and patient-reported outcomes at 6 months after surgery compared with the non-sarcopenia group. Severe sarcopenia was adversely associated with postoperative clinical outcomes in patients undergoing THA.

Autologous Peripheral Blood Stem Cell Transplantation and Timing of Local Radiation Therapy in Patients With Malignant Lymphoma: Results of the Japanese Radiation Oncology Study Group Questionnaire Survey.

Malignant lymphoma (ML) including Hodgkin's lymphoma and non-Hodgkin's lymphoma is often treated with local radiation therapy (RT) in combination with autologous hematopoietic stem cell transplantation (ASCT) to prevent relapse; however, the efficacy and optimal timing of this approach is unclear. In this study, a national survey conducted by the Japanese Radiation Oncology Study Group reviewed ML cases from 2011 to 2019 to determine whether RT should be added to ASCT, focusing on the use of autologous peripheral blood stem cell transplantation (auto-PBSCT), a predominant form of ASCT. The survey encompassed 92 patients from 11 institutes, and assessed histological ML types, treatment regimens, timing of RT relative to auto-PBSCT, and associated adverse events. The results indicated no significant differences in adverse events, including myelosuppression, based on the timing of RT in relation to auto-PBSCT. However, anemia was more prevalent when RT was administered before auto-PBSCT, and there was a higher incidence of neutropenia recovery delay in patients receiving RT after auto-PBSCT. This study provides valuable insights into the variable practices of auto-PBSCT and local RT in ML treatment, emphasizing the need for optimized timing of these therapies to improve patient outcomes and reduce complications.

New advances in the protective mechanisms of acidic pH after ischemia: Participation of NO

BackgroundIt has been previously demonstrated that the maintenance of ischemic acidic pH or the delay of intracellular pH recovery at the onset of reperfusion decreases ischemic-induced cardiomyocyte death. ObjectiveTo examine the role played by nitric oxide synthase (NOS)/NO-dependent pathways in the effects of acidic reperfusion in a regional ischemia model. MethodsIsolated rat hearts perfused by Langendorff technique were submitted to 40 min of left coronary artery occlusion followed by 60 min of reperfusion (IC). A group of hearts received an acid solution (pH = 6.4) during the first 2 min of reperfusion (AR) in absence or in presence of l-NAME (NOS inhibitor). Infarct size (IS) and myocardial function were determined. In cardiac homogenates, the expression of P-Akt, P-endothelial and inducible isoforms of NOS (P-eNOS and iNOS) and the level of 3-nitrotyrosine were measured. In isolated cardiomyocytes, the intracellular NO production was assessed by confocal microscopy, under control and acidic conditions. Mitochondrial swelling after Ca2+ addition and mitochondrial membrane potential (Δψ) were also determined under control and acidosis. ResultsAR decreased IS, improved postischemic myocardial function recovery, increased P-Akt and P-eNOS, and decreased iNOS and 3-nitrotyrosine. NO production increased while mitochondrial swelling and Δψ decreased in acidic conditions. l-NAME prevented the beneficial effects of AR. ConclusionsOur data strongly supports that a brief acidic reperfusion protects the myocardium against the ischemia-reperfusion injury through eNOS/NO-dependent pathways.

Assessment of cerebrovascular alterations induced by inflammatory response and oxidative–nitrative stress after traumatic intracranial hypertension and a potential mitigation strategy

The rapid perfusion of cerebral arteries leads to a significant increase in intracranial blood volume, exposing patients with traumatic brain injury to the risk of diffuse brain swelling or malignant brain herniation during decompressive craniectomy. The microcirculation and venous system are also involved in this process, but the precise mechanisms remain unclear. A physiological model of extremely high intracranial pressure was created in rats. This development triggered the TNF-α/NF-κB/iNOS axis in microglia, and released many inflammatory factors and reactive oxygen species/reactive nitrogen species, generating an excessive amount of peroxynitrite. Subsequently, the capillary wall cells especially pericytes exhibited severe degeneration and injury, the blood–brain barrier was disrupted, and a large number of blood cells were deposited within the microcirculation, resulting in a significant delay in the recovery of the microcirculation and venous blood flow compared to arterial flow, and this still persisted after decompressive craniectomy. Infliximab is a monoclonal antibody bound to TNF-α that effectively reduces the activity of TNF-α/NF-κB/iNOS axis. Treatment with Infliximab resulted in downregulation of inflammatory and oxidative–nitrative stress related factors, attenuation of capillary wall cells injury, and relative reduction of capillary hemostasis. These improved the delay in recovery of microcirculation and venous blood flow.

Flight delay propagation in the multiplex network system of airline networks

The flight delay propagation and recovery processes in airline networks differ due to differences in airline network structures, capacity distributions, and base airport locations. When each airline network is regarded as a network layer, flight delay propagation and interaction in a multiplex network system (MNS) composed of multiple airlines will become more complex and variable. In this paper, flight delays from different airlines are considered propagation sources, and an MNS-based flight delay propagation model is established under the framework of the susceptible-infected-susceptible model. By comparing the independent propagation process of delays in a single-layer airline network and the interactive propagation process of delays in an MNS, we investigate the impact of network structure on flight delays to propose corresponding delay control strategies for different airlines. The results show that unlike in single-layer networks, in an MNS, the behavior of airlines at an airport facilitates or inhibits delay propagation in other layers by influencing the network characteristics and propagation rate. The same airport may even play different roles in different layers, depending on the function it has. Therefore, not all flights are infected or have aggravated delays when accessing the MNS; instead, they are impacted by combined factors such as on-time performance, network structure, and flight interaction.

Zinc isotopic evidence for enhanced continental weathering and organic carbon burial in the Early Silurian

The Late Ordovician and Early Silurian periods experienced glaciation and mass extinctions. However, debates exist regarding the factors that initiated the glaciation and the subsequent delay in biotic recovery. To uncover the relationships between paleoclimate, marine redox states, and biotic recovery in the Early Silurian, temporal variations in Zinc (Zn) isotopic compositions along with other multi-geochemical proxies were analyzed for a carbonate-dominated section in South China. A stratigraphic δ66Zn trend was found in studied section, indicating a widespread disturbance to the marine Zn cycle. A significant negative shift in δ66Zn by up to ∼0.7 ‰ was observed immediately following the Hirnantian Glaciation and HICE, which can be attributed to a combination of reduced burial efficiency of organic carbon, fast weathering of large igneous provinces and increased riverine Zn input. This was followed by a ∼ 0.4 ‰ rise in δ66Zn values, alongside a sharp decrease in δ13C values, indicating an increase in sulfide precipitation (e.g., ZnS, FeS) due to expansions of euxinia. Subsequently, a notable rise in δ66Zn values by up to ∼1.1 ‰ is interpreted as an increase in organic carbon burial, given the concurrent variation of δ66Zn and δ13C during this period. The findings suggest that the increase in organic carbon burial, a reduction in reverse weathering, or a combination of them contributed to the glaciation in Silurian. Furthermore, the weathering-induced high primary productivity led to anoxic water conditions in the latest Hirnantian and Rhuddanian. This prolonged marine anoxia in seawater thus caused the deposition of organic-rich sediments and hindered biotic recovery in the Rhuddanian.