Faster Rehabilitation Research Articles

Application of enhanced recovery after surgery in the perioperative nursing of cerebral glioma patients

Objective To explore the safety and effectiveness of enhanced recovery after surgery (ERAS) in the perioperative nursing of cerebral glioma patients. Methods ERAS optimized nursing was developed based on ERAS of other specialties combined with neurosurgical features. A total of 80 cerebral glioma patients recruited in the Department of Neurosurgery of Tang Du Hospital from June 2016 to April 2017 were investigated and divided into the experimental group (40 cases) and control group (40 cases) using the envelope random sampling with the registration number assigned when a patient was admitted to the hospital. Patients in the control group were treated with routine treatment, while patients in the experimental group received the ERAS nursing. The complications, nursing satisfaction rate, the time of taking food, removing urine tube, stopping the infusion and hospital stay were compared between two groups. Results There was no significant difference in the occurrence of complications between two groups (P>0.05) . The nursing satisfaction rate was 82.5% in the experimental group and 62.5% in the control group with significant difference between two groups (P<0.05) . The rate of removing urine tube within 24 hours after surgery was 85.0% in the experimental group and 25.0% in the control group; the bed activity rates within 3 days after surgery in the experimental and control groups were 95.0% and 30.0% respectively; the differences between two groups were statistically significant (P<0.05) . The time of taking food, stopping the infusion and hospital stay in the experimental group were significantly shorter than those of the control group (P<0.05) . Conclusions The application of ERAS in the perioperative nursing of cerebral glioma patients is safe and effective, which allows faster rehabilitation, and reduces postoperative hospital stay and hospitalization costs. Key words: Cerebral glioma; Perioperative nursing; Enhanced recovery after surgery

COMplex Fracture Orthopedic Rehabilitation (COMFORT) - Real-time visual biofeedback on weight bearing versus standard training methods in the treatment of proximal femur fractures in the elderly: study protocol for a multicenter randomized controlled trial

BackgroundProximal femur fractures are a common injury after low energy trauma in the elderly. Most rehabilitation programs are based on restoring mobility and early resumption of weight-bearing. However, therapy compliance is low in patients following lower extremity fractures. Moreover, little is known about the relevance of gait parameters and how to steer the rehabilitation after proximal femur fractures in the elderly. Therefore, the aim of this prospective, randomized controlled trial is to gain insight in gait parameters and evaluate if real-time visual biofeedback can improve therapy compliance after proximal femur fractures in the elderly.MethodsThis is a two-arm, parallel-design, prospective, randomized controlled trial. Inclusion criteria are age ≥ 60 years, a proximal femur fracture following low energy trauma, and unrestricted-weight bearing. Exclusion criteria are cognitive impairment and limited mobility before trauma. Participants are randomized into either the control group, which receives care as usual, or the intervention group, which receives real-time visual biofeedback about weight-bearing during gait in addition to care as usual. Spatiotemporal gait parameters will be measured in 94 participants per group during a 30-m walk with an ambulatory biofeedback system (SensiStep). The progress of rehabilitation will be evaluated by the primary outcome parameters maximum peak load and step duration in relation to the discharge date. Secondary outcome parameters include other spatiotemporal gait parameters in relation to discharge date. Furthermore, the gait parameters will be related to three validated clinical tests: Elderly Mobility Scale; Functional Ambulation Categories; and Visual Analogue Scale. The primary hypothesis is that participants in the intervention group will show improved and faster rehabilitation compared to the control group.DiscussionThe first aim of this multicenter trial is to investigate the normal gait patterns after proximal femur fractures in the elderly. The use of biofeedback systems during rehabilitation after proximal femur fractures in the elderly is promising; therefore, the second aim is to investigate the effect of real-time visual biofeedback on gait after proximal femur fractures in the elderly. This could lead to improved outcome. In addition, analysis of the population may indicate characteristics of subgroups that benefit from feedback, making a differentiated approach in rehabilitation strategy possible.Trial registrationTrialRegister.nl, NTR6794. Registered on 31 October 2017.

Unicompartmental knee replacement – An underrated alternative of total knee replacement: A matched comparative study analysing their benefits and risks in local population

IntroductionThe demand of knee arthroplasty is increasing worldwide with aging population. Even though unicompartmental knee replacement is associated with fewer complications namely stroke, myocardial infarction, thrombo-embolism, blood transfusion and mortality, it merely comprises 3–8% of knee arthroplasties. The aim of the study is to establish the role of unicompartmental knee replacement by evaluating the benefits and risks of unicompartmental knee replacement versus total knee replacement in Hong Kong population. MethodsAll unicompartmental knee replacement performed in our institute from 2011 to 2014 were reviewed. Comparative analyses were performed on pre-operative, operative and post-operative parameters. Primary total knee replacement performed in the same period was chosen as control group with 1:1 matching for age, sex, BMI and pre-operative range of motion. ResultsThere were 46 unicompartmental knee replacement. It comprises 3.3% of all knee arthroplasties in our institute. The mean follow-up time was 12.8 months (4–38 months). There was no significant difference in all pre-operative parameters except WOMAC score. All operative parameters favored unicompartmental knee replacement significantly (operation time 76 vs 91 minutes; wound size 7.5 vs 12.4 cm; haemoglobin drop 0.75 vs 2.46g/dl, p < 0.05). Early post-operative parameters also favored unicompartmental knee replacement (Deep vein thrombosis rate 4.3 vs 23.9%; length of stay 5.4 vs 7.0 days, p < 0.05). There was no infection or mortality in both groups. ConclusionBecause of less operative risk and faster rehabilitation, this study suggested that unicompartmental knee replacement is more cost effective and might be a better choice for patients with unicompartmental arthritis in local population.

Sublingual sufentanil tablet system Zalviso\xae for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study

BackgroundCurrently many TKA protocols rely on multimodal analgesic protocols with patient-controlled analgesia systems that administer opioids through a patient controlled IV infusion pump, in addition to concomitant peripheral nerve blocks and local anesthetics. Although effective, PCA IV opioids do not provide optimal results with fast track rehabilitation protocols.MethodsThe present is a retrospective study comparing the novel sublingual sufentanil PCA system (SSTS) to our standard of care foreseeing continuous femoral nerve block (cFNB) within a multimodal analgesic in a TKA fast-track protocol. The study evaluated 95 patients on SSTS (SSTS group) and 87 on cFNB (cFNB/control group) and collected data on numeric rating scores for pain from day 1–3 after surgery (T1, T2, T3), both at rest (NRS) and during movement (mNRS), patient’s ability to walk, need for supplementary analgesia (rescue dose), occurrence of adverse effects, length of hospital stay, and usability rating for SSTS by both patients and hospital staff.ResultsNRS at rest was lower in the cFNB than in the SSTS group for all 3 days after surgery, whereas mNRS scores were lower in the SSTS group at all time points measured. Adverse effects were significantly fewer among patients of the SSTS group (6% patients) than those of the cFNB (74% patients) (p < 0.001). Rescue doses were needed by 5% of SSTS patients vs 60% of cFNB. The fewer adverse events and lower pain scores for the SSTS group were associated to a notably better ability to ambulate, with all patients (100%) of the SSTS group being able to stand and walk for 10 m from T1 on; patients in the cFNB group showed a slower recovery with only 40% being able to stand and walk on T1, 70% on T2 and 85% on T3. All patients of the SSTS group had a length of stay of 4 days (day of surgery plus 3 after) as foreseen by the fast track protocol, in comparison only 36% of cFNB. Lastly, patient and nursing staff judged SSTS easy to use.ConclusionOur experience suggests that SSTS is a valuable strategy for routine postoperative analgesia following TKA in the context of a multimodal analgesic approach within the fast-track setting.

Hybrid myocardial revascularization.

In patients with advanced coronary artery disease (CAD), coronary artery bypass grafting (CABG) is associated with improved long-term outcomes while percutaneous coronary intervention (PCI) is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach, hybrid myocardial revascularization (HMR).Three strategies for timing of the hybrid revascularization exists, each with their own inherent advantages and shortcomings: (1) CABG followed by PCI, (2) PCI followed by CABG, or (3) simultaneous CABG + PCI in a hybrid suite. The results of the first randomized control trial comparing HMR (CABG first) and standard CABG, POL-MIDES (Prospective Randomized PilOt Study EvaLuating the Safety and Efficacy of Hybrid Revascularization in MultIvessel Coronary Artery DisEaSe), show HMR was feasible for 93.9% of patients whereas conversion to standard CABG was required for 6.1%. At 1year, both groups had similar all-cause mortality (CABG 2.9% vs. HMR 2%) and major adverse clinical event (MACE)-free survival rates (CABG 92.2% vs. HMR 89.8%). Results of observational and comparative studies show that minimally invasive HMR procedures in patients with multivessel CAD carry minimal perioperative mortality risk and low morbidity and do not increase the risk of postoperative bleeding. The advantage they offer in comparison to classical surgical revascularization is indeed faster rehabilitation and patient's return to normal life. Hybrid myocardial revascularization has been developed as a promising technique for the treatment of high-risk patients with CAD. Hybrid revascularization using minimally invasive surgical techniques combined with PCI offers to a part of patients an advantage of optimal revascularization of the most important artery of the heart, together with adequate myocardial revascularization in a relatively delicate way. Indeed, to patients with high operative risk of standard surgery, it offers an alternative which should be considered carefully.

OZONE THERAPY IN LEG ULCERS OF PATIENTS WITH CHRONIC VENOUS INSUFFICIENCY

The term chronic venous insufficiency – CVI (due to a deep vein thrombosis, valvular insufficiency or both) indicates a pathologic condition characterized by alterations of the venous flow and is the main cause in the formation of ulcers in the lower limbs, creating an important socio-medical problem, which finally leads the patient to a total disability for the rest of his/her life. In healthy leg veins, one-way valves allow blood to move only in one direction: upstream towards the heart. This prevents the backward flow of blood, back down the legs. However, in disease leg veins, the valves are enlarged and retracted, in such way, that they become unable to block the retrograde venous flow being the main cause for the appearance of ulcers in the lower limbs. Taking into account the different therapeutic effects of ozone as: improvement of oxygen metabolism and blood rheologic properties, stimulation of the antioxidant defense system achieving the cell redox balance, modulation of the immunological system and nitric oxide, as well as its great germicide power, among others, the aim of this study was to evaluate the efficacy of ozone therapy on the healing process of chronic ulcers of the lower limb in comparison with conventional treatment. A controlled and randomized phase III clinical trial was performed in 90 hospitalized patients with ulcers (over 2 years of evolution, with a diameter of no less than 5 cm) of the lower limbs due to CVI. Efficacy was evaluated according to the least time of hospital stay, which was the necessary time for the lesions to heal or when they were aseptic or their granulation tissue was ready for skin graft. In the cases where the patient did not want to be skin grafted, he/she was discharged and continued treatment at home with topic OLEOZON® (sunflower ozonated oil). The sample was divided at random into 3 groups of 30 patients each: 1-Control group (conventional treatment): venous repose (leg elevation), hyposodic diet, analgesics, daily cure with saline solution and fomentation with antiseptic solutions, several times per day. 2-Ozone group (M-AHT): venous repose (leg elevation), hyposodic diet, analgesics and local ozone treatment (bagging) and topical OLEOZON®, once per day, combining with M-AHT (3 times per week), up to 10 sessions (50 mg/L and 50 mL in 100 mL of blood). 3-Ozone group (Rectal): As M-AHT group but using rectal ozone application up to 20 sessions, once per day (50 mg/L and 200 L). No systemic or local antibiotics were used in the study. Results indicated an average length hospital stay of (53.1 ± 13.9) d for the control group and of (31.5 ± 6.7) d for both ozone group, with significant differences between control and ozone groups. Therefore, hospital stay was reduced for patients with ulcers in the lower limbs treated by ozone therapy, with the subsequent economic saving. No significant differences were observed between the two ozone groups in length hospital stay. No adverse reactions were seen. Ozone therapy can be considered as another treatment within the therapeutical supply for this condition, which could provide a fast rehabilitation for patients as well as their incorporation to a useful life.

From RATS to VATS: why we did choose this way.

Minimally invasive thoracic surgery has become standard in many centers over the last years. While surgeons agree on the benefits like less pain, shorter hospital stay and faster rehabilitation, there is an ongoing debate about the best minimally invasive approach. Besides the number and size of incisions (multiport, uniportal, etc.), the question of the optimal platform became more and more important.

Primary Anterior Cruciate Ligament Repair With Augmentation

Anterior cruciate ligament (ACL) tears are usually managed by reconstruction with autograft or allograft, but primary repair in carefully selected patients is a reasonable option. Proximal avulsions presenting early with excellent tissue quality are amenable to repair and healing. Restoration of native ACL preserves its proprioceptive and kinematic functions. A repair is less invasive and avoids graft-related problems, and faster rehabilitation is possible. Protection for the repair in the early stages will allow better healing. We present our technique of ACL repair using knotless suture anchors with high-strength sutures and protection using high-strength sutures tapes inserted through the same anchors.

Сучасні методи хірургічного лікування поєднаної патології анального каналу і прямої кишки

Актуальність проблеми поєднаної патології анального каналу і прямої кишки досить висока, що на сьогодні зумовлено стрімко зростаючою кількістю проктологічних захворювань, а також відсутністю єдиного підходу щодо хірургічного лікування цієї категорії пацієнтів. Крім того, вивченню даної проблеми присвячена досить незначна кількість публікацій з результатами наукових досліджень. Серед ускладнень після комбінованих операційних втручань на анальному каналі і прямій кишці з приводу їх поєднаної патології найчастіше зустрічаються рубцеві стриктури анального каналу, недостатність анального сфінктера, а також грубі рубцеві деформації періанальних і параректальних ділянок та промежини. Впродовж останнього десятиліття широкого застосування набули “гібридні” операції в лікуванні хронічного геморою III–IV стадії в комбінації з іншою патологією анального каналу і прямої кишки. Вони включають поєднання деартеріалізації гемороїдальних вузлів із мукопексією або латексне лігування гемороїдальних вузлів, їх ліфтинг та мукопексію з видаленням супутньої патології анального каналу. У зв’язку із прогресивним розвитком сучасних технологій у практику колопроктологів почали швидко впроваджуватись такі сучасні методи хірургічного лікування аноректальної патології, як електротермічна система “Liga Sure”, ультразвуковий гармонічний скальпель “Ultra Cision”, лазерні технології в лікуванні анальних тріщин, хронічного геморою та парапроктиту (LHP, FiLaC), плазменний скальпель, біполярна системи “En Seal”, радіохвильовий скальпель “Surgitron”, а також методики LIFT (ligation of intersphincteric fistula tract) та VAAFT (Video Assisted Anal Fistula Treatment), які зменшили тривалість операцій, об’єм крововтрати, інтенсивність больового синдрому, але, на жаль, не позбавили пацієнтів таких ускладнень, як рецидиви захворювання, післяопераційні кровотечі та рубцеві стриктури анального каналу.Отже, актуальність проблеми поєднаної патології анального каналу і прямої кишки спонукає до розробки і впровадження в клінічну практику нових високоефективних методів хірургічного лікування даної патології, які б забезпечували відсутність ускладнень в післяопераційному періоді і швидку медико-соціальну реабілітацію пацієнтів.

Trans-Cervical Femoral Fractures in Young Adults: The Prognosis is not only in the Hands of Orthopaedic Surgeons

Hip fractures are still a very difficult problem in emergency rooms all over the world. They are increasingly common due to increasing numbers of road accidents and aging population. They are among the most expensive injuries treated in emergency rooms. If surgical indications are rather well codified for older injured, the goals to achieve for younger ones is quite different. Restoring or preserve the femoral head vascular supply is of utmost importance and requires a perfect coordination between emergency specialists and orthopaedic surgeons. In this context, reducing the delay between the injury and consider these fractures as real surgical emergencies as well as improving surgical techniques to allow a fast rehabilitation are the management options which can help emergency teams to improve their final results. For these traumas the preservation of the femoral head is the goal we all expect to achieve.

Comparing unicompartmental to total knee arthroplasty in medial gonarthritis: study protocol for 2-year follow-up of a randomized controlled trial

Background and objectives: Since the 1990s, unicompartmental knee arthroplasty (UKA) are again starting to gain interest worldwide. A mere 3.5% of all knee arthroplasties performed in Sweden 2014 were UKAs, whereas up to 25% had knee osteoarthritis isolated to the medial side. Reasons for this discrepancy might be that UKAs are considered more technically demanding, thus requiring more surgical training, and that long-term survival of these implants has been inferior compared to total knee arthroplasty (TKA). This has been addressed by improving surgical instruments and discontinuation of underperforming implants, and by improving surgical technique including mini-invasive incision and patient selection. In support of using the less surgically invasive UKA, a few cohort studies show less pain, fewer hospital days, and faster rehabilitation. However, to the best of our knowledge, there is a lack of high quality randomized clinical trials (RCTs) showing unequivocal clinical superiority of UKA compared to TKA. The aim of the present study is to compare changes in muscle mass, strength, performance based measures (PBMs), and patient reported outcome measures (PROMs) in patients randomized to UKA or TKA. Design: A 2-year follow-up RCT. Methods: The study will include 80 patients with medial knee osteoarthritis, aged 50 years or more, who will be scheduled for a knee replacement and equally randomized to either TKA or UKA. Outcome measures: The primary outcome is muscle mass change at 6 weeks, 6, 12 and 24 months post-operatively measured by computed tomography. Secondary outcomes are PBMs, PROMs, muscle strength, and 3D motion analysis at the same occasions. Discussion: Although patients subjected to total hip arthroplasty are typically satisfied with their surgical results, patients with TKA are less so. It is of importance to improve surgical procedure, and less invasive surgery of the knee might be a solution. Ethics and dissemination: The study has been approved by the Regional Ethics Committee in Stockholm (DNR: 2014/1895-31/3) and will be conducted in accordance with the ethical principles of the Declaration of Helsinki. All patients will sign a consent form after being given oral and written information of the study. Patient recruitment began in November 2015 and will end in December 2019. Data collection will complete in June 2021. We plan to present results in open access scientific publications and at scientific conferences and meetings. Trial registration: The study protocol was registered with ClinicalTrials.gov (identifier: NCT 02563756) on September 18, 2015. Protocol version: 1.0.

Post-Operative Outcome of Achilles Tendon Injury Treated with Knotless Percutaneous Achilles Repair System

Background: The Achilles tendon is the most frequently ruptured tendon in the body and its incidence is increasing, more so among athletes. Various surgical techniques exist for treating it and one of these is as discussed in this study, Achilles tendon injury treated with Knotless PARS (Arthrex) that allows for earlier weight bearing and mobilization and, therefore, faster rehabilitation and an improved functional outcome. Aim: The post-operative progress of patients, specifically athletes subset with Achilles tendon injury treated with Knotless PARS is discussed in this article using Newcastle Orthopaedic Foot and Ankle Score (NOFAS). Methods: We retrospectively evaluated the patients operated on between March 2015 and January, 2017, 19 feet of 19 patients diagnosed with acute Achilles tendon rupture were treated. All clinical outcomes were examined using the Newcastle Orthopaedic Foot and Ankle Score (NOFAS) in patients operated in the last 28 months after the operation. We measured their progress in 3 categories as follows: (1) Improvement in pain and symptoms. (2) Recovery and lifestyle improvement and (3) Motion and activity. Conclusion: The study suggests that the post-operative progress of patients with Achilles tendon injury treated with Knotless PARS (Arthrex) is strong, but the best results only appear in patients post 12 months of their surgery. We suggest, prospective and comparative studies will help for further research of this subject.

No effect of conventional vs. minimally invasive surgical approach on clinical outcome and migration of a short stem total hip prosthesis at 2-year follow-up: A randomized controlled study

BackgroundShort stem hip prostheses have become a viable alternative for the treatment of hip osteoarthritis. In combination with minimally invasive surgery, short stem hip prostheses offer potential advantages of reduced surrounding tissue damage and faster rehabilitation. However, the limited perioperative visibility of these minimally invasive techniques may lead to reduced primary stability compared to conventional techniques. We hypothesized: a) increased migration of the minimally invasive group due to reduced primary stability and b) increased clinical scores of the minimally invasive group. MethodsSixty total hip arthroplasty patients were randomly assigned to undergo minimally invasive anterolateral modified Watson-Jones or conventional Hardinge surgery. All patients were treated with a Metha short stem prosthesis. Roentgen stereophotogrammetry and clinical scores were calculated after surgery and at 3, 6, 12, and 24months postoperatively. FindingsNo statistically significant differences in implant migration and clinical scores were observed between the minimally invasive and conventional groups at any follow-up point. The largest average resultant migrations were 1.22 (SD 1.31) mm (conventional) and 1.18 (SD 1.18) mm (minimally invasive) after 24months. The mean Harris Hip Score score improved from 54 (SD 10, conventional) and 52 (SD 13, minimally invasive) preoperatively to 97 (SD 5, both groups) after 24months. InterpretationOverall, the differences in implant migration and clinical scores between the minimally invasive and conventional surgery groups were marginal and not clinically relevant. The data from this study suggest that good results can be expected from both the investigated approaches.

Posterior Fibular Groove Deepening Procedure With Low-Profile Screw Fixation of Fibrocartilaginous Flap for Chronic Peroneal Tendon Dislocation

Chronic peroneal tendon dislocation is an uncommon disorder that frequently presents with concomitant pathology. Posterior fibular groove deepening and retinaculum repair have been increasing in popularity for treatment of peroneal tendon dislocations. The purpose of the present study was to introduce a posterior fibular groove deepening procedure using low-profile snap-off screws to securely and simply fix the fibrocartilaginous flap to facilitate faster rehabilitation and to assess the clinical outcomes of patients with chronic peroneal tendon dislocation and associated pathologic features. In the present retrospective case series, 34 ankles in 34 patients underwent the fibular groove deepening procedure using low-profile screws with superior peroneal retinaculum repair. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and patient subjective satisfaction rate. The time of return to recreational and sports activities was also assessed. Weightbearing ankle radiographs were evaluated to assess the stability of the flap by checking the screws. The mean follow-up period was 47.96 (range 12 to 142) months. The mean AOFAS scale score for all patients improved from 69.96 ± 13.14 to 87.72 ± 10.13 at the last follow-up examination (p < .001). Overall, 85.3% of patients subjectively rated their operative outcomes as excellent or good. The 18 (52.9%) patients with an isolated peroneal tendon dislocation had a faster return to recreational or sports activities than the 16 (47.1%) patients with concomitant pathologic features (2.95 ± 0.19 versus 4.14 ± 1.34 months; p = .002). No patient experienced residual dislocation, screw loosening, or irritation from the screws. The fibular groove deepening procedure using low-profile screws is be a simple procedure that offers rigid fixation. This leads to relatively fast rehabilitation and resumption of recreational or sports activities.

Aphakic Artisan/Verisyse IOLs as retropupillary implants : Video article

The retropupillary implantation of an iris claw intraocular lens (IOL) is an uncomplicated and fast technique for rehabilitation of aphakic eyes without any capsular structures and is presented in avideo in the online version of this article. Acomplete anterior pars plana vitrectomy as shown in our case or an extensive preceding anterior vitrectomy as well as an intact iris are prerequisites. Special instruments for the implantation and fixation of the IOL are available to optimize the operative procedure. In addition to a rapid operating time the advantages of atrained surgeon are low complications rates and fast rehabilitation. For eyes with a defective iris diaphragm, ischemic vitreoretinopathy and uveitis, other implantation techniques should be selected.

Change of paradigm in the surgical treatment of metastatic diseases of bone. Part I. Bony metastases of the extremities and pelvis

According to the statistical data of tumor registries the incidence of cancer has increased in the last decade, however the mortality shows only a slight change due to the new and effective multimodal treatments. The aim of our overview article is to present the changes in the survival of the metastatic patients, and to demonstrate which factors influence their prognosis. The improvement of survival resulted in a more active surgical role both in metastases of the bone of the extremities and the pelvis. We present a diagnostic flow chart and current options for the reconstruction of the different regions of the bone and skeleton, and we will discuss their potential advantages, disadvantages and complications. It is evident that apart from the impending and pathological fracture surgery it is not the first choice of treatment but rather a palliative measure. The aim of surgery is to alleviate pain, to regain mobility and improve quality of life. If possible minimal invasive techniques are performed, as they are less demanding and allow fast rehabilitation for the patient, and they are solutions that last for a lifetime. In optimal conditions radical curative surgery can be performed in about 10 to 15 per cent of the cases, and better survival is encouraging. Orv Hetil. 2017; 158(40): 1563-1569.

P 66 Transcranial DC stimulation enhances recovery of swallowing function after stroke – a randomized clinical and MEG trial

Introduction Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation tool that has shown some potential to aid motor rehabilitation following stroke. In the present clinical and neuroimaging study we evaluated whether tDCS is able to speed up the recovery of swallowing function in acute dysphagic stroke patients. Besides relating clinical effects with neuroplastic changes in cortical swallowing processing we aimed to identify factors influencing treatment success. Material and methods In this single-center, double-blind, randomized study (NCT01970384), 60 acute dysphagic stroke patients received anodal tDCS (20 min, 1 mA) or sham stimulation over the contralesional swallowing motor cortex on four consecutive days. If the patient’s condition allowed it, swallowing exercises were performed during stimulation. Swallowing function was thoroughly assessed before and after the study intervention using the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), the dysphagia limit swallow test and two clinical scores, the Dysphagia Severity Rating Scale (DSR) and the Functional Oral Intake Scale (FOIS). In 15 patients, cortical swallowing-associated activation could be recorded during a volitional swallowing task applying 270-channel whole-head MEG before and after the treatment intervention. Results 59 patients completed the study. One patient suffered from recurrent stroke during the study period and was therefore excluded. Study groups did not differ according to demographic data or stroke characteristics. Time from admission to study intervention was 116 h in mean in both groups. Baseline FEDSS, FOIS, DSR and dysphagia limit were comparable. Following stimulation, patients from the treatment group showed significantly greater improvement in FEDSS (1.3 vs 0.4 points, p When looking for indicators of treatment success in the stimulation group only, there was a trend towards a greater improvement of all assessed swallowing scores with early treatment initiation (p Discussion According to our clinical and neurophysiological data, application of tDCS over the contralesional swallowing motor cortex supports cortical swallowing network reorganization, thereby leading to faster rehabilitation of acute post stroke dysphagia. The positive effect was independent of patient age and stroke characteristics, suggesting tDCS as a suitable treatment option for a broad patient population. Early treatment initiation within the suspected time window of maximum neuroplasticity after stroke seems to be beneficial.

Preoperative Factors Influencing Decision Between Hemiarthroplasty and Total Hip Arthroplasty in Femoral Neck Fractures in Indian Patients-Retrospective Single-Center Study.

Introduction:The percentage of elderly population is increasing worldwide, with increasing incidence of femoral neck fractures. An increasing trend of arthroplasty for femoral neck fracture is observed. We aim to retrospectively analyze the preoperative factors that seem to influence the decision between hemiarthroplasty and total hip arthroplasty for managment of the same.Materials and Methods:Patients admitted with femoral neck fracture during January 2010 to March 2015 in our institute were included in the study. The preinjury independency status was assessed using Katz index scoring system. Based on the data obtained from case sheets, the patients were segregated into hemiarthroplasty group and total hip arthroplasty group. Variables that preferentially appeared in the individual group were identified.Results:A total of 206 hips of 199 patients were included in the study. The factors that seem to influence the decision between hemiarthroplasty and total hip arthroplasty with a statistical significance were age, Katz index score, and American Society of Anesthesiologists (ASA) grade. Higher ASA grades caused delay in surgery, increasing the length of hospital stay, and these patients more commonly underwent hemiarthroplasty.Discussion:Patients’ preinjury functional status influenced the decision between hemiarthroplasty and total hip arthroplasty, especially in the age between 65 and 80 years. Preoperative comorbidities did not prevent the patient from undergoing total hip replacement due to early optimization for surgery with the help of the dedicated orthogeriatric team.Conclusion:We conclude that preinjury functional independency of a patient is an important decisive factor in the choice between hemiarthroplasty and total hip arthroplasty. In addition to other factors including age and comorbidity pattern, scoring methods for preinjury functional status of patient could aid in decision-making. Early optimization, early surgery, and faster rehabilitation help the patients to achieve their preinjury functional status.

Functional Outcomes after Surgical Treatment of Hand Fractures - ORIF vs. CRIF Analysis

Hand fractures are the most common fractures presenting at both accident and emergency and within emergency clinics. Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. These decisions are dependent on a wide range of factors including age, hand dominance, occupation and co-morbidities. Usually, conservative treatment is the best solution for the patients but the indication for such treatment should be really precise. Unstable or multiple fractures are treated in a surgical manner, more or less invasive. When surgical treatment is the main indication, the hand surgeon has to choose the best bone implant, which can assure fast rehabilitation of the hand. We report our surgical experience in hand fractures that includes metacarpal and phalanges fractures and different bone implants application: Kirschner wires, mini-plates and screws and external fixation. We designed a retrospective clinical study on 32 patients that were treated in our department during the interval 2015-2016. Rehabilitation of the hand after surgery is the most important aspect of treatment, because it is necessary in every patient, and because it is no use splinting or operating on a hand if it ends up stiffed. Stable fixation of fractures and early mobilization will prevent stiffness and will be the key for successfully treatment of hand fractures. This can be possible only when the surgeon will choose the best way of treatment using different type of surgical management.

Modified protocol for enhanced recovery after surgery is beneficial for Chinese cancer patients undergoing pancreaticoduodenectomy.

Radical surgical resection remains the only effective treatment for advanced pancreatic cancer. Effective protocols for recovery from post-operative complications that result in high rates of morbidity and mortality are therefore essential. The enhanced recovery after surgery (ERAS) protocol is an interdisciplinary multimodal concept based on modern anesthesia and analgesia combined with other fast rehabilitation parameters. It was first applied in the field of elective colorectal surgery, and eventually extended to several surgical diseases. In this study, we investigated the feasibility and safety of implementing the ERAS protocol in patients undergoing pancreaticoduodenectomy (PD). We randomly divided 159 patients who underwent PD into two groups who were managed using either ERAS or the conventional protocol. We observed that in those treated with the ERAS protocol several post-operative recovery factors were greatly improved, and there were no complications requiring readmission. We therefore propose that ERAS can improve post-operative recovery of PD patients and shorten the waiting time to chemotherapy, which may improve the overall survival of surgically treated pancreatic cancer patients.