Index Of Recovery Research Articles

Assessment of effect of two different doses of dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery

: To evaluate two different doses of dexmedetomidine infusion on emergence agitation and measurement of hemodynamics, bispectral index, cortisol levels, and quality of recovery in patients who underwent nasal surgery under general anaesthesia.94 individuals of either sex between the ages of 18 and 65 who experienced nasal surgery under general anesthesia were split into two groups for this randomized experimental study. Before induction, each group received loading doses of dexmedetomidine (DEX) infusion at a rate of 1 µg/kg over a period of 10 minutes. Group B underwent a standard induction and then received an infusion of 0.4μg/kg/h of dexmedetomidine every hour until they were extubated, while group A received an infusion of 0.8μg/kg/h. Sevoflurane was employed for maintenance. During emergence, the frequency of agitation, cough hemodynamic parameters, and recovery traits were assessed. Patients received the Quality of Recovery (QoR-40) questionnaire 24 hours following surgery.The hemodynamic reaction to laryngoscopy and intubation was blunted and the intubating circumstances were improved by both doses equally well. Group A's intraoperative mean PR and MAP were significantly (P<0.05) lower than group B's. Coughing was more common among the subjects in group A. A statistically significant difference was found between groups in comparing emergence agitation. Cortisol levels were significantly higher postoperatively in the 0.4µg/kg dose of dexmedetomidine 0.8µg/kg/ group (p=0.001). Global QoR-40 score at 24 h after surgery showed a better global recovery profile in group A. :Although a greater dose of DEX may have more hemodynamic adverse effects, it may also reduce the incidence of emergent agitation, the surgical stress response, and a smoother recovery profile.

Takotsubo syndrome: left atrial and ventricular myocardial strain impairment in the subacute and convalescent phases assessed by CMR.

We investigated the differences in impairment of left ventricle (LV) and left atrium (LA) contractile dysfunction between subacute and convalescent takotsubo syndrome (TTS), using myocardial strain analysis by cardiac magnetic resonance (CMR) feature-tracking technique. We retrospectively selected 50 patients with TTS clinical-radiological diagnosis who underwent CMR within 30days since symptoms onset: 19 studied during the early subacute phase (sTTS, ≤ 7days) and 31 during the convalescence (cTTS, 8-30days). We measured the following: LV global longitudinal, circumferential, and radial strain (lvGLS, lvGCS, lvGRS) and strain rate (SR) and LA reservoir (laS_r), conduit (laS_cd), and booster pump strain (laS_bp) and strain rate (laSR_r, laSR_cd, laSR_bp). Patients were compared with 30 age- and sex-matched controls. All patients were women (mean age 63years). TTS patients showed altered LV- and LA-strain features, compared to controls. sTTS was associated with increased laS_bp (12.7% versus 9.8%) and reduced lvEF (47.4% versus 54.8%), lvGLS (-12.2% versus 14.6%), and laS_cd (7.0% versus 9.5%) compared to cTTS (p ≤ 0.029). The interval between symptoms onset and CMR was correlated with laS_bp (r = -0.49) and lvGLS (r = 0.47) (p = 0.001 for both). At receiver operating characteristics analysis, laS_bp was the best discriminator between sTTS and cTTS (area under the curve [AUC] 0.815), followed by lvGLS (AUC 0.670). LA dysfunction persists during the subacute and convalescence of TTS. laS_bp increases in subacute phase with progressive decrease during convalescence, representing a compensatory mechanism of LV dysfunction and thus a useful index of functional recovery. Atrial strain has the potential to enhance the delineation of cardiac injury and functional impairment in TTS patients, assisting in the identification of individuals at higher risk and facilitating the implementation of more targeted and personalized medical therapies. • In TTS, after ventricular recovery, atrial dysfunction persists assessable with CMR feature tracking. • Quantitative assessment of atrial strain discriminates atrial functions: reservoir, conduit, and booster pump. • Atrial booster pump changes after acute TTS, regardless of ventricular function. • Atrial strain may serve as a temporal marker in TTS.

Vertebral Body Reshaping after Fractures: An Important Index of Recovery in Glucocorticoid-Treated Children.

In this 6-year study we identified factors associated with spontaneous vertebral body reshaping in glucocorticoid (GC)-treated children with leukemia, rheumatic disorders, and nephrotic syndrome. Subjects were 79 children (mean age 7.4 years) who had vertebral fracture (VF) evaluation on lateral spine radiographs at least 1 year after VF detection. VF were graded using the modified Genant semiquantitative method and fracture burden for individuals was quantified using the spinal deformity index (SDI; sum of grades from T4 to L4). Sixty-five children (82.3%) underwent complete vertebral body reshaping (median time from VF detection to complete reshaping 1.3 years by Cox proportional hazard modeling). Of 237 VF, the majority (83.1%) ultimately reshaped, with 87.2% reshaping in the thoracic region vs 70.7% in the lumbar region (P = .004). Cox models showed that (1) every g/m2 increase in GC exposure in the first year after VF detection was associated with a 19% decline in the probability of reshaping; (2) each unit increase in the SDI at the time of VF detection was associated with a 19% decline in the probability of reshaping [hazard ratio (HR) = 0.81; 95% confidence interval (CI) = 0.71, 0.92; P = .001]; (3) each additional VF present at the time of VF detection reduced reshaping by 25% (HR = 0.75; 95% CI = 0.62, 0.90; P = .002); and (4) each higher grade of VF severity decreased reshaping by 65% (HR = 0.35; 95% CI = 0.21, 0.57; P < .001). After experiencing a VF, children with higher GC exposure, higher SDI, more severe fractures, or lumbar VF were at increased risk for persistent vertebral deformity.

Influence of physical post-exercise recovery techniques on vagally-mediated heart rate variability: A systematic review and meta-analysis.

In sports, physical recovery following exercise-induced fatigue is mediated via the reactivation of the parasympathetic nervous system (PNS). A noninvasive way to quantify the reactivation of the PNS is to assess vagally-mediated heart rate variability (vmHRV), which can then be used as an index of physical recovery. This systematic review and meta-analysis investigated the effects of physical recovery techniques following exercise-induced fatigue on vmHRV, specifically via the root mean square of successive differences (RMSSD). Randomized controlled trials from the databases PubMed, WebOfScience, and SportDiscus were included. Twenty-four studies were part of the systematic review and 17 were included in the meta-analysis. Using physical post-exercise recovery techniques displayed a small to moderate positive effect on RMSSD (k = 22, Hedges' g = 0.40, 95% confidence interval [CI] = 0.20-0.61, p = 0.04) with moderate heterogeneity. In the subgroup analyses, cold water immersion displayed a moderate to large positive effect (g = 0.75, 95% CI: 0.42-1.07) compared with none for other techniques. For exercise type, physical recovery techniques performed after resistance exercise (g = 0.69, 95% CI: 0.48-0.89) demonstrated a larger positive effect than after cardiovascular intermittent (g = 0.52, 95% CI: 0.06-0.97), while physical recovery techniques performed after cardiovascular continuous exercise had no effect. No significant subgroup differences for training status and exercise intensity were observed. Overall, physical post-exercise recovery techniques can accelerate PNS reactivation as indexed by vmHRV, but the effectiveness varies with the technique and exercise type.

Self-processing in coma, unresponsive wakefulness syndrome and minimally conscious state.

Behavioral and cerebral dissociation has been now clearly established in some patients with acquired disorders of consciousness (DoC). Altogether, these studies mainly focused on the preservation of high-level cognitive markers in prolonged DoC, but did not specifically investigate lower but key-cognitive functions to consciousness emergence, such as the ability to take a first-person perspective, notably at the acute stage of coma. We made the hypothesis that the preservation of self-recognition (i) is independent of the behavioral impairment of consciousness, and (ii) can reflect the ability to recover consciousness. Hence, using bedside Electroencephalography (EEG) recordings, we acquired, in a large cohort of 129 severely brain damaged patients, the brain response to the passive listening of the subject's own name (SON) and unfamiliar other first names (OFN). One hundred and twelve of them (mean age ± SD = 46 ± 18.3 years, sex ratio M/F: 71/41) could be analyzed for the detection of an individual and significant discriminative P3 event-related brain response to the SON as compared to OFN ('SON effect', primary endpoint assessed by temporal clustering permutation tests). Patients were either coma (n = 38), unresponsive wakefulness syndrome (UWS, n = 30) or minimally conscious state (MCS, n = 44), according to the revised version of the Coma Recovery Scale (CRS-R). Overall, 33 DoC patients (29%) evoked a 'SON effect'. This electrophysiological index was similar between coma (29%), MCS (23%) and UWS (34%) patients (p = 0.61). MCS patients at the time of enrolment were more likely to emerged from MCS (EMCS) at 6 months than coma and UWS patients (p = 0.013 for comparison between groups). Among the 72 survivors' patients with event-related responses recorded within 3 months after brain injury, 75% of the 16 patients with a SON effect were EMCS at 6 months, while 59% of the 56 patients without a SON effect evolved to this favorable behavioral outcome. About 30% of severely brain-damaged patients suffering from DoC are capable to process salient self-referential auditory stimuli, even in case of absence of behavioral detection of self-conscious processing. We suggest that self-recognition covert brain ability could be an index of consciousness recovery, and thus could help to predict good outcome.

Influence of self-healing property of Ultra-High Performance Concrete under aggressive environment

This paper investigates the evolution of self-healing properties of ultra-high performance concrete exposed to aggressive environments. Double edge wedge splitting UHPC specimens with 0.8% crystalline admixture and 1.5% steel fibre by volume have been first pre-cracked up to a average 0.30 mm crack opening displacement (COD) obtained by two linear variable differential transformers attached to both sides of the sample surface. Then, the pre-cracked samples have been exposed to three different environments: tap water, salt water (a NaCl aqueous solution at 3.3% concentration) and geothermal water obtained from a geothermal power plant. After one month exposure, samples were carried out re-crack to know the self-healing properties. The results from ultrasonic pulse velocity tests (UPV) reveal that the samples exposed to tap water exhibit the highest rate of recovery along the exposure time, while those exposed to geothermal water show the lowest. The calculated indexes of cracking self-healing (ICS) show a 73.8% closure in tap water, 58.4% in salt water 43.9% in geothermal water. Additionally, the index of damage recovery, evaluated from UPV frequencies as well as from the stress vs. COD curves of pre-cracking and post-healing re-cracking tests on specimens, and the equivalent tensile stress also indicate a higher level of healing capable of inducing a significant recovery of mechanical properties.

Personal space increases during the COVID-19 pandemic in response to real and virtual humans.

Personal space is the distance that people tend to maintain from others during daily life in a largely unconscious manner. For humans, personal space-related behaviors represent one form of non-verbal social communication, similar to facial expressions and eye contact. Given that the changes in social behavior and experiences that occurred during the COVID-19 pandemic, including “social distancing” and widespread social isolation, may have altered personal space preferences, we investigated this possibility in two independent samples. First, we compared the size of personal space measured before the onset of the pandemic to its size during the pandemic in separate groups of subjects. Personal space size was significantly larger in those assessed during (compared to those assessed before) the onset of the pandemic (all d > 0.613, all p < 0.007). In an additional cohort, we measured personal space size, and discomfort in response to intrusions into personal space, longitudinally before and during the pandemic, using both conventional and virtual reality-based techniques. Within these subjects, we found that measurements of personal space size with respect to real versus virtual humans were significantly correlated with one another (r = 0.625–0.958) and similar in magnitude. Moreover, the size of personal space, as well as levels of discomfort during personal space intrusions, increased significantly during (compared to before) the COVID-19 pandemic in response to both real and virtual humans (all d > 0.842, all p < 0.01). Lastly, we found that the practice of social distancing and perceived (but not actual) risk of being infected with COVID-19 were linked to this personal space enlargement during the pandemic (all p < 0.038). Taken together, these findings suggest that personal space boundaries expanded during the COVID-19 pandemic independent of actual infection risk level. As the day-to-day effects of the pandemic subside, personal space preferences may provide one index of recovery from the psychological effects of this crisis.

STATISTICAL ASSESSMENT OF THE ECONOMIC RESILIENCE OF THE REGIONS OF THE REPUBLIC OF BELARUS

The article discusses the main approaches to the definition of a relatively new term for economic science - economic resilience of territories. The author made an attempt to assess the level of economic resilience of the regions of Belarus on the basis of the 2015-2016 recession resistance index. and the index of recovery of economic dynamics in the post-recession period (2017-2019). This is the first time an analytical work of this level has been carried out in Belarus. It has been established that the central regions of the country - Minsk and the Minsk region - have high economic resilience. The author outlines the prospects for the use and methodological problems of assessing the economic resilience of regions in statistical science.

Estudio piloto para la inyección de bactericidas en arenas con problemas de actividad microbiana en el Campo Libertador, Bloque-57

Microbial activity can lead to problems such as corroded tubing, formation plugging, and decreased effective permeability, especially the sulfate-reducing bacteria that have the formation water as a medium that allows their proliferation. These adhere to the conductive channels of the producing sand and form biomass that restricts the flow of fluids. This work was carried out to design a non-reactive matrix stimulation by injecting biocides that clean the sand face to increase permeability, reduce formation damage, control corrosive environments, and increase daily oil production. By analyzing the total concentration of iron, sulfate, carbon dioxide, sulfide in gas and water, wells with microbial activity were identified, while the behavior of the bacteria was characterized by evaluating bacterial cultures and corrosion coupons. Using economic profitability criteria, the TTT A 011 and TAP 09 wells were selected as the most prospective in the Libertador field since, out of the 94 wells analyzed, they presented the highest index of microbial activity and recovery of oil barrels. The microbial activity in the wells of the Tetete station is more aggressive, since they reproduce in less time, clogging the porous channels at a faster rate. The THPS and GLH bactericides had better functionality against bacteria and the environment, so they were considered in this design of non-reactive matrix stimulation generating $907,976.10 as profit for the company in the 12-month projection.

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

BackgroundHigh levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR.MethodsWe retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24 h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths.ResultsEleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24 h PaO2 (306 ± 121 mmHg vs 164 ± 53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24 h (an index of native cardiac recovery). The mean 24 h PaO2 was significantly and positively correlated with the severity of hypotension and the intensity of vasoactive therapies. Patients dying from circulatory failure died after a median of 17 h, compared to a median of 58 h for patients dying from a neurological cause. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements.ConclusionIn conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.

Reactive immunosuppression in stroke patients: The role in neurorehabilitation

There is a close connection between the central nervous system and the immune system. This balance can be impaired in the presence of severe brain damage, i.e. in case of stroke. The consequences of stroke on the balance between these two systems are cerebral inflammation and immunosuppression. The aim of this study is to verify whether lymphopenia may represent a negative prognostic index of functional recovery in the Neurorehabilitative setting.

Two Major Elements of Life Recovery After a Disaster: Their Impacts Dependent on Housing Damage and the Contributions of Psycho-Behavioral Factors

Clarification of the individual factors determining the speed and quality of life recovery after massive disasters is crucial in assessing the vulnerability and resilience of individuals and communities. The research, however, remains in its infancy in that the index of life recovery per se is yet to be established; researchers have utilized different sets of variables, and their importance seems to vary across recovery phases potentially reflecting the change in housing situation. In addition, previous research on promoting factors of life recovery has primarily focused on demographic factors and inadequately addressed the psychological and behavioral factors, which has large educational and cultural implications. In this study, to address these two issues, we analyzed the survey data of the 2011 Great East Japan Earthquake and Tsunami disaster. First, from the multiple questionnaire items relevant to the situations of life recovery, we extracted the major elements by factor analysis and investigated their relationship to subjective sense of life recovery. At this time, we compared the relationships obtained between victims who lost their housing and those who did not. Then, we examined the psycho-behavioral as well as demographic factors promoting these life-recovery elements. The factor analysis provides two recovery elements: Well-being (health and social connections) and Housing Recovery (integrity of residential environment). The main determinant of subjective sense of life recovery was the housing recovery element for victims who had lost their houses, while it was the well-being element for those who did not experience housing loss. Among the demographic factors, a robust effect of income on the housing recovery element was identified in both victim groups while the effect of age and household structures on the two elements varied between groups. We clarified that different psycho-behavioral factors promoted two life-recovery elements. Across groups, contribution of leadership to the housing recovery element and that of neuroticism (negative), emotional regulation, and active well-being to the well-being element were identified. The former finding is consistent with the importance of consensus building in housing reconstruction, and the latter may reflect the role of common psycho-behavioral capacity oriented to individuals’ well-being including social aspects. The two life-recovery elements and their promoting factors thus identified may provide a parsimonious macroscopic framework for the evaluation and promotion of life recovery from disasters, and have practical utility for an educational approach to strengthening community resilience.

Метод радіочастотної нейроабляції в лікуванні больового синдрому крижово-клубового суглоба

Актуальність. У формуванні больових синдромів попереково-крижової локалізації провідну роль відіграє дисфункція крижово-клубового зчленування. Радіочастотна нейроабляція крижово-клубового суглоба (ККС) може бути альтернативним методом лікування больового синдрому при неефективності внутрішньосуглобових ін’єкцій гормональних препаратів. Множинні дослідження підтверджують дані про значну ефективність радіочастотної нейроабляції нервів, що іннервують ККС, терміном на 6–12 міс. Мета дослідження: провести аналіз ефективності застосування радіочастотної нейроабляції крижово-клубових суглобів. Матеріали та методи. Проаналізовані дані 48 пацієнтів (12 чоловіків і 36 жінок) віком від 53 до 90 років, які пройшли амбулаторне лікування у відділенні реабілітації ДУ «Інститут травматології та ортопедії НАМН України». Результати. Було встановлено зниження больового синдрому за візуально-аналоговою шкалою (регресування болю на 3–10 балів) через 12 міс. у 83 % пацієнтів. За результатами оцінки якості життя (анкетування з використанням анкети Роланда-Морріса) через 12 міс. вірогідне поліпшення спостерігалося у 77,16 % пацієнтів. Аналізуючи результати лікування (за індексом одужання) через 12 міс. встановлено: відмінний результат — у 38 %, добрий — у 42 % пацієнтів, задовільний — у 20 % (серед них погіршення порівняно з вихідним станом відзначали 8,3 % пацієнтів). Висновки. Радіочастотна нейроабляція — ефективний метод лікування больового синдрому крижово-клубового суглоба. Ефект від процедури довготривалий (більше 12 міс.), при рецидиві больового синдрому можливе проведення повторних процедур.

Stimulated autogenous-healing capacity of fiber-reinforced mortar incorporating healing agents for recovery against fracture and mechanical properties

Abstract This study aimed to investigate the effect of autogenous healing capacity with the addition of expansive and crystalline agents on mechanical and fracture behaviors of fiber-reinforced (FR) mortar specimens with crack mouth opening displacement (CMOD) controlled test set-up. The experimental results of a self-healing approach of FR mortar were analyzed in terms of first cracking peak load (FCPL) increase, index of fracture toughness recovery (IFTR), and index of fracture energy recovery (IFER). Initially, the specimens were pre-cracked at different crack widths ranging from 30 μm to 200 μm after 28-days of curing. After pre-cracking, the specimens were kept in water for 56- and 120-day healing. A controlled three-point bending test (PBT) was applied on prism specimen having a central notch of 40 mm depth for pre-cracking as well as the post-conditioning stage for determining the FCPL. However, the crack surfaces were monitored by a high-range digital microscope and scanning electron microscope (SEM) to examine the nature of healed products near the damaged area. Test results revealed that a significant recovery of small cracks (≤50 μm) could be achieved for self-healing specimens by using healing agents (HA), while for large cracks (≥100 μm) partial recovery could be achieved after the 120-day healing period.

Glucocorticoid-Induced Osteoporosis: Why Kids Are Different.

Glucocorticoids (GC) are an important risk factor for bone fragility in children with serious illnesses, largely due to their direct adverse effects on skeletal metabolism. To better appreciate the natural history of fractures in this setting, over a decade ago the Canadian STeroid-associated Osteoporosis in the Pediatric Population (“STOPP”) Consortium launched a 6 year, multi-center observational cohort study in GC-treated children. This study unveiled numerous key clinical-biological principles about GC-induced osteoporosis (GIO), many of which are unique to the growing skeleton. This was important, because most GIO recommendations to date have been guided by adult studies, and therefore do not acknowledge the pediatric-specific principles that inform monitoring, diagnosis and treatment strategies in the young. Some of the most informative observations from the STOPP study were that vertebral fractures are the hallmark of pediatric GIO, they occur early in the GC treatment course, and they are frequently asymptomatic (thereby undetected in the absence of routine monitoring). At the same time, some children have the unique, growth-mediated ability to restore normal vertebral body dimensions following vertebral fractures. This is an important index of recovery, since spontaneous vertebral body reshaping may preclude the need for osteoporosis therapy. Furthermore, we now better understand that children with poor growth, older children with less residual growth potential, and children with ongoing bone health threats have less potential for vertebral body reshaping following spine fractures, which can result in permanent vertebral deformity if treatment is not initiated in a timely fashion. Therefore, pediatric GIO management is now predicated upon early identification of vertebral fractures in those at risk, and timely intervention when there is limited potential for spontaneous recovery. A single, low-trauma long bone fracture can also signal an osteoporotic event, and a need for treatment. Intravenous bisphosphonates are currently the recommended therapy for pediatric GC-induced bone fragility, typically prescribed to children with limited potential for medication-unassisted recovery. It is recognized, however, that even early identification of bone fragility, combined with timely introduction of intravenous bisphosphonate therapy, may not completely rescue the osteoporosis in those with the most aggressive forms, opening the door to novel strategies.

Cardiotocography monitoration in antepartum care: analysis of controls

Abstract Introduction WHO does not recommend the routine prenatal cardiotocography (CTG) during pregnancy to improve maternal and perinatal outcomes. Instead, Italian guidelines consider CTG after the 41st week of pregnancy to be useful. The aim of this work was to identify the variables associated with CTG performed before the 40th week. Materials and Methods A retrospective study was conducted at the Hospital of Siena (Italy), all females that accessed to CTG from 2016 to 2018 was included. The variables were: nationality, pregnancy associated pathology(PAP), gestational age(GA), parity, type of access (urgent/programmed), n° of accesses, active fetal movements (AFM), amniotic fluid index (AFI) and necessity of recovery. The statistical analysis was carried out using Stata 12. Results The women included were 4010, mean age was 32.8±5.6 years (75% Italian; 62.4% primiparous). A mean GA was 38 ± 3 weeks; 47.5% had one access, 27% two accesses, 14% three accesses. The 22% were urgent accesses, 11.5% had PAP (70% diabetes mellitus). The 58% showed up before the 40th week, the probability was higher for non-Italian women (OR 1.3), multiparous (OR 1.32), women with urgent access (OR 7.9) and women with PAP (OR 3.4). In 5.4% the CTG was altered, 23% had absent AFM and 2% had alterated AFI. Females that came before 40th week were more likely to have absent AFM (OR 4.5) and AFI (OR 2). The 3% needed an immediate hospitalization, mainly in non-Italian (OR 1.7), urgent accesses (OR 4.4), those that came before 40th week (OR 2.44), absent AFM (OR 21.8), and altered AFI (OR 15.8), Conclusions Our analysis shows the association between precocious access to CTG and urgent medical condition and PAP as expected, but also with other variable as parity and nationality. The low GA without an indication of high risk at the moment of the access suggests the possible overmedicalization of pregnancy. It seems useful to review clinical practices to ensure obstetric care close to best practice. Key messages As literature reports, to avoid overmedication of pregnancy cardiotocography should not be performed before the 41st week of pregnancy. In some situations the CTG is anticipated and for this reason it seems useful to review the clinical practices implemented in order to ensure obstetric care close to best practice.

Minimal-invasive triangular fixation with orthopaedic robot for unilateral unstable sacral fracture

Objective To compare the clinical outcomes between minimal-invasive triangular fixation with orthopedic robot and traditional open fixation method for unilateral unstable sacral fracture patients. Methods Data of 24 consecutive patients with unilateral unstable sacral fracture who were treated from August 2014 to February 2018 were retrospectively analyzed. All patients were associated with anterior ring injuries of pelvis and received magnetic resonance of nerve (MRN) preoperatively to exclude the compression of sacral nerve by bone. All patients received surgical treatment of sacral fractures with triangular fixation and the fixation of pelvic anterior ring injuries simultaneously and two groups were divided according to the different surgical methods of sacral fractures. There were 10 males and 2 females with an average age of 36.3±1.2 years in the orthopaedic robot group. According to Dennis classification, there were 4 type I and 8 type II fractures. Two patients were associated with nerve injuries (Gibbons II 1 case, III 1 case). In traditional posterior-midline open fixation group, there were 11 males and 1 female with an average age of 38.2±1.6 years. According to Dennis classification, there were 3 type I and 9 type II fractures. Three patients were associated with nerve injuries (Gibbons II 2 cases, III 1 case). The clinical data of two group patients were collected and compared statistically. T test was used to compare the operation time, intraoperative bleeding, intraoperative fluoroscopy times, Majeed function assessment which was to evaluate the patients' clinical prognosis and healing time of fracture. χ2 test was used to compare the healing rate of fracture, accuracy assessment of fixation insertion, and Mears radiological assessment which was applied to evaluate the reduction quality of fractures. The rank sum test was used to compare Gibbons score which was applied as the index of neurological deficiency recovery. The Fisher exact test was used to compare the infection rate. Results All patients were followed up continuously for an average time of 21.2±3.2 months. The average operation time of robot group was 100.3±14.5 minutes, meanwhile the open fixation group was 202.0±18.5 min. The average intraoperative bleeding of robot group was 180.0±17.4 ml, meanwhile the open fixation group was 850.0±15.2 ml. The average intraoperative fluoroscopy time of robot group was 23.3±4.5 s, meanwhile the open fixation group was 90.0±7.7 s. All fractures were healed and no loss of reduction or fail of fixation occurred in both groups. The healing time of fracture of robot group was 8.5±1.9 months, meanwhile the open fixation group was 12.8±2.4 months. The satisfaction rates of reduction which was based on Mears-Velyvis radiological criterion of both groups were 91.7%. The accuracy rate of fixation insertion of robot group was 100% meanwhile the open fixation group was 77.78%. Majeed function assessment score of robot group was 86.2±3.4, meanwhile the open fixation group was 84.2±2.7. There was no infection occurred in robot group, meanwhile 3 patients infected in open fixation group. The Gibbons score of one patient changed from II preoperative to I postoperative and one case changed from III preoperative to II postoperative in robot group, meanwhile two patients changed from II preoperative to I postoperative and one case changed from III preoperative to II postoperative in open fixation group. The healing rate of fracture, infection rate, Majeed function assessment, Mears-Velyvis radiological evaluation criterion and Gibbons score of two groups had no significant statistical difference (P >0.05), meanwhile the operation time (t=14.99), intraoperative bleeding (t=100.46), intraoperative fluoroscopy time (t=32.13), healing time of fracture (t=4.87) and accuracy rate of fixation insertion (χ2=9.00) of orthopedic robot group were better than traditional open group and had the significant difference (P< 0.05). Conclusion The minimal-invasive triangular fixation with orthopedic robot for unilateral unstable sacral fracture had the advantages of less operation time, less intraoperative bleeding and less times of fluoroscopy, more accurate of fixation insertion and less healing time of sacral fractures compared to traditional open fixation method and should be recommended as an effective and advanced choice. Key words: Sacrum; Fractures, bone; Fracture fixation, internal; Internal fixators

Smoking abstinence symptoms across 67 days compared with randomized controls-Moderation by nicotine replacement therapy, bupropion, and negative-affect traits.

Accurate knowledge of negative affect (NA)-related smoking abstinence symptoms (SAS) severity and duration and their moderation by pharmacotherapy and NA-related personality traits is critical for efficacious treatments given that elevated state and trait NA are predictors of relapse. However, SAS severity, duration, and moderation are not well characterized. To date, the longest randomized controlled trial (RCT) of NA-related SAS using randomized delayed-quit smoking controls only examined symptoms across 45 days, despite clinical evidence that SAS may last longer. The present RCT assessed SAS across 67 days in dependent smokers (N = 95) who were randomized either to quit or to delay quitting for the course of the trial. The quit group was further randomized to receive either nicotine replacement therapy (NRT), bupropion (BUP), or placebo. Abstinence-related increases in anger-irritability, depressive, anxiety, and general NA symptoms did not resolve relative to the delayed quit group (DQG) levels across the 67 days in any of the 3 quit groups, though craving fell to below DQG and prequit levels. While NRT attenuated Day 3 SAS relative to BUP and placebo, BUP and NRT generally did not reduce SAS. High scores on trait measures of NA/neuroticism predicted greater increases in and duration of NA-related SAS, potentially indicating that smoking abstinence unmasks affective symptoms. Positive affect was not impacted by abstinence or treatment. The results support the views that (a) prequit baseline values are not a valid index of NA SAS recovery, and (b) on average, NA-related SAS take longer than 67 days to resolve. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Heart rate variability in the tegu lizard, Salvator merianae, its neuroanatomical basis and role in the assessment of recovery from experimental manipulation

Using long-term, remote recordings of heart rate (fH) on fully recovered, undisturbed lizards, we identified several components of heart rate variability (HRV) associated with respiratory sinus arrhythmia (RSA): 1.) A peak in the spectral representation of HRV at the frequency range of ventilation. 2.) These cardiorespiratory interactions were shown to be dependent on the parasympathetic arm of the autonomic nervous system. 3.) Vagal preganglionic neurons are located in discrete groups located in the dorsal motor nucleus of the vagus and also, in a ventro-lateral group, homologous to the nucleus ambiguus of mammals. 4.) Myelinated nerve fibers in the cardiac vagus enabling rapid communication between the central nervous system and the heart. Furthermore, the study of the progressive recovery of fH in tegu following anesthesia and instrumentation revealed that ‘resting’ levels of mean fH and reestablishment of HRV occurred over different time courses. Accordingly, we suggest that, when an experiment is designed to study a physiological variable reliant on autonomic modulation at its normal, resting level, then postsurgical reestablishment of HRV should be considered as the index of full recovery, rather than mean fH.

Effect of indapamide and bisoprolol monotherapy on cerebrovascular reactivity in hypertensive patients with rheumatoid arthritis

Aim. To investigate the effect of indapamide and bisoprolol monotherapy on cerebrovascular reactivity (CVR) in patients with combined hypertension (HT) and rheumatoid arthritis (RA).Materials and Methods. A total of 66 patients with HT grade 1-2 and RA (average age of 59.0 ± 7.5 years) were included in an open-controlled randomized study in parallel groups. Group 1 included 33 patients treated with indapamide 2.5 mg/day. Group 2 included 33 patients treated with bisoprolol 6.0 ± 2.6 mg/day. We performed 24-h blood pressure monitoring and transcranial Doppler ultrasound of the middle cerebral arteries (MCA) with assessment of CVR during hyperoxia and hypercapnia tests before and after 24 weeks of treatment.Results. Indapamide treatment improved CVR parameters during hypercapnia test. The MCA peak systolic velocity increased significantly from 53.7 [34.8; 67.8] to 55.8 [37.6; 69.0] сm/s (p = 0.017). Bisoprolol treatment worsened CVR parameters during hypercapnia test. The speed modification of MCA blood flow velocity decreased significantly from 0.10 [0.05; 0.19] to 0.08 [-0.01; 017] cm/s2 (p = 0.032). The index of recovery of MCA blood flow velocity decreased significantly from 1.11 [0.95; 1.27] to 0.84 [0.78; 1.08] (p = 0.006)Conclusion. Indapamide treatment improved CVR parameters, but bisoprolol treatment worsened CVR parameters during hypercapnia test in patients with combined HT and RA.