Longer Recovery Time Research Articles

Postdrought Recovery Time Across Global Terrestrial Ecosystems

AbstractDrought, as an intermittent disturbance of the water cycle, profoundly impacts the terrestrial ecosystem. Recovery time (RT) of an ecosystem from drought is an important indicator of assessing drought impacts and ecosystem resilience, yet the spatiotemporal pattern of ecosystem postdrought RT remains controversial in existing studies. Here we investigate the spatiotemporal pattern of postdrought RT across global terrestrial ecosystems using two observation‐based gross primary productivity (GPP) data sets: direct flux‐site observations and gridded estimates by upscaling flux‐site observations using machine‐learning approach. For droughts that occur on average once every 5.2 years, the RT typically ranges between 2 and 8 months, with a global mean RT of ∼6 months. Spatially, both GPP data sets show a significant bilinear relationship between RT and moisture gradient, and that ecosystems in arid and humid regions tend to recover from drought more rapidly than semi‐arid/sub‐humid ecosystems. Additionally, forests show an overall longer RT than shrublands and grasslands. Temporally, global ecosystem RT shows a slight yet significant increasing trend (0.032 months yr−1) during 1982–2010, which is partly caused by the increasing drought for the same period. However, the observed patterns of RT across global bio‐climatic zones are not captured by the state‐of‐the‐art land surface models, which exhibit a shorter RT in semi‐arid/sub‐humid ecosystems but longer RT in arid/humid regions, and a larger increasing trend of RT over time (0.069 months yr−1). Our findings provide crucial insights into ecosystem vulnerability to sub‐decadal stress events and ecosystem recovery trajectories among diverse bio‐climatic regions and highlight potential model deficiencies that should be accounted for in future model developments.

110 Long term follow up on barbed sutures in sacrocolpopexy

Apical pelvic organ prolapse (POP) is conventionally managed with abdominal sacrocolpopexy (SCP). However, due to its associated morbidities and longer recovery times, a minimally invasive approach via robotic-assisted sacrocolpopexy (RSCP) is gaining popularity with success rates of 87-100%. In addition, self-anchoring barbed sutures (SABs) has been introduced of suturing Y- shaped vaginal mesh in RSCP. This avoids knot tying with less time and aggravation. In our study, we demonstrated the long-term anatomical success and reoperation rates with SABs in RSCP. Under an IRB-approved protocol (IRB #19-0167), we retrospectively reviewed patients with symptomatic stage 2 or higher POP based on the Pelvic Organ Prolapse Quantification system (POP-Q) who underwent RSCP at a tertiary care academic medical center from January 2016 to October 2017. The placement of the Y-shaped vaginal mesh with 3-0 V Loc was consistent across all surgeries and performed by the same surgeon. Follow-up examinations were performed at intervals up to two years. Postoperative POP-Q scores <0 indicate anatomical correction without prolapse symptoms. Baseline demographics of patients were summarized by frequencies and percentages for categorical variables and by mean/median, standard deviation, and ranges for continuous variables. Descriptive univariate statistics were performed by SPSS Statistics. Fifty-five patients underwent RSCP with the mean age of 59.3 years. Seventeen patients were lost to follow-up and were excluded from the study. Of the 38 patients, the POP-Q system classified 28.9% with stage 2, 63.2% with stage 3 and 5.3% with stage 4 POP at baseline. A history of prior hysterectomy was noted in 55.3% of the patients and 31.6% of patients had a previous POP surgery. In our study, 42.1% underwent a hysterectomy with SCP, 18.4% a Burch urethropexy with SCP, 44.7 % a midurethral sling with SCP, and 5.3% of the patients solely underwent a sacrocolpopexy with no cases converted to open surgery. Our patients had an anatomical success rate of 86.8% with no mesh erosion on the 2-year postoperative follow-up. The complication rate was 7.9% due to intraoperative bladder injuries and were repaired primarily. Three patients had stage 2 prolapse and two patients had stage 3 prolapse on follow-up with a reoperation rate of 10.5%. of Our study suggests using RSCP with 3-0 SABs for vaginal wall mesh fixation as a favorable management for POP with low perioperative complication and reoperation rates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effects of Adverse Drug Reactions and Adverse Drug Events in Hospital Admission Rates and Re-Hospitalization of Patients

Background: ADRs and ADEs have a great potential to hospitalize and/or re-hospitalize patients. According to McDonnell and Jacobs, one ADR or ADE could lead a patient to a hospital length of stay of an average of 6.1 days. This can lead to lost days of work, a longer recovery time and even economic implications. Methods: A thorough evaluation of the relevant extracted literature has been analyzed thoroughly in order to find out how ADRs and ADEs impact the levels of hospitalization and re-hospitalization of patients and whether strategies, such as reporting systems, can aide in decreasing their overall occurrence. Results: As the level of hospital admissions/re-hospitalizations due to ADRs and ADEs depends on different factors, such as age and location, the data is separated in the following categories: pediatric population, general adult populations and geriatric population. Where data were available, location has been specified within each category as well. Conclusion: ADR and ADE-related hospital admission and readmission rates are age-group related, elderly being at the highest risk. However, these rates are not dependent on whether a country is developed or developing. Also, there are strategies that can be utilized by healthcare providers in order to decrease these rates in the future, such as to provide medication reviews and follow-ups.

Synthesis and gas sensing properties of NiO/ZnO heterostructured nanowires

In this study, we report on the synthesis of the NiO/ZnO heterostructured nanowires by a facile two-step liquid phase route and their gas sensing characteristics employing Au interdigitated electrodes integrated on a miniature ceramic heater. Microstructural characterizations indicate that flocculent NiO particles are uniformly assembled on the outer surfaces of the single-crystalline ZnO nanowires, with diameters around 50 nm and lengths ranging from 500 nm to several μm. The gas sensing investigation indicates that the sensors based on NiO/ZnO heterostructured nanowires exhibit high sensitivity towards ethanol, good reversibility, reproducibility, stability, robustness towards humidity, and fast response/recovery rates at the determined optimum operating temperature of 300 °C. Interestingly, the sensor shows higher ethanol response but longer recovery time in N2 compared with those in air. An ethanol sensing mechanism is proposed to explain the experimental results.

Effects of dexmedetomidine doses on postoperative cognitive dysfunction and serum β- amyloid and cytokine levels in elderly patients after spine surgery: a randomized controlled trial

To explore the immunomodulatory mechanism and optimal dose of dexmedetomidine (DEX) for preventing postoperative cognitive dysfunction (POCD) in elderly patients undergoing spinal surgery. A total of 120 elderly patients undergoing elective spinal surgery with general anesthesia were randomized into 4 groups to receive a loading dose of 0.3 μg/kg DEX for 10 min before anesthesia induction followed by maintenance doses of 0.2, 0.5, and 0.8 μg · kg-1·h-1 (low-, medium-, and high-dose DEX groups, respectively) or an equal volume of normal saline (control group). DEX and saline was discontinued 40 min before the end of the surgery. Before induction (D0) and on day 1 (D1), day 3 (D2) and day 7 (D3) after the operation, the cognitive function of the patients was assessed using the MMSE scale and their serum levels of β-amyloid (Aβ), TNF-α, IL-1β and IL-6 were measured. The occurrence of adverse effects including bradycardia and hypotension and the recovery time of the patients were recorded. Compared with those on D0, serum levels of Aβ, IL-1β, IL-6, and TNF-α on D1 were markedly increased in all the groups (P < 0.05); the levels of Aβ decreased to the baseline level on D3 in medium- and high-dose DEX groups (P > 0.05) but remained high in the other two groups. On D2, TNF-α, L-1β and IL-6 recovered their baseline levels in medium- and high-dose DEX groups (P > 0.05) but remained elevated in the other two groups. The incidences of POCD in medium- and high-dose DEX groups were comparable but significantly lower than that in the control group (P < 0.05). The incidences of hypotension and bradycardia were the highest in high-dose DEX group (P < 0.01), which also had longer recovery time than the other 3 groups (P < 0.05). With a loading dose of 0.3 μg/kg followed by a maintenance doses of 0.5 μg · kg-1·h-1, DEX can effectively reduce the incidence of POCD in elderly patients undergoing spinal surgery by inhibiting the production of Aβ and pro-inflammatory cytokines.

The Dynamic Response of Nitrogen Transformation to the Dissolved Oxygen Variations in the Simulated Biofilm Reactor.

Lab-scale simulated biofilm reactors, including aerated reactors disturbed by short-term aeration interruption (AE-D) and non-aerated reactors disturbed by short-term aeration (AN-D), were established to study the stable-state (SS) formation and recovery after disturbance for nitrogen transformation in terms of dissolved oxygen (DO), removal efficiency (RE) of NH4+-N and NO3−-N and activity of key nitrogen-cycle functional genes amoA and nirS (RNA level abundance, per ball). SS formation and recovery of DO were completed in 0.56–7.75 h after transition between aeration (Ae) and aeration stop (As). In terms of pollutant REs, new temporary SS formation required 30.7–52.3 h after Ae and As interruptions, and seven-day Ae/As interruptions required 5.0% to 115.5% longer recovery times compared to one-day interruptions in AE-D and AN-D systems. According to amoA activity, 60.8 h were required in AE-D systems to establish new temporary SS after As interruptions, and RNA amoA copies (copy number/microliter) decreased 88.5%, while 287.2 h were required in AN-D systems, and RNA amoA copies (copy number/microliter) increased 36.4 times. For nirS activity, 75.2–85.8 h were required to establish new SSs after Ae and As interruptions. The results suggested that new temporary SS formation and recovery in terms of DO, pollutant REs and amoA and nirS gene activities could be modelled by logistic functions. It is concluded that temporary SS formation and recovery after Ae and As interruptions occurred at asynchronous rates in terms of DO, pollutant REs and amoA and nirS gene activities. Because of DO fluctuations, the quantitative relationship between gene activity and pollutant RE remains a challenge.

Evaluation of Three Medetomidine-Based Anesthetic Protocols in Free-Ranging Wild Boars (Sus scrofa).

Three medetomidine-based drug protocols were compared by evaluating time courses, reliability and physiological effects in wild boars. A total of 21 cage-trapped wild boars (Sus scrofa) were immobilized using one of the following drug combinations; MTZ: medetomidine (0.2 mg/kg) + tiletamine-zolazepam (2.0 mg/kg), MK: medetomidine (0.15 mg/kg) + ketamine (5 mg/kg), and MKB: medetomidine (0.1 mg/kg) + ketamine (5.0 mg/kg) + butorphanol (0.2 mg/kg). Induction time, recovery time, and physiological variables were recorded and arterial blood gas analysis measured twice, before and after 15 min of oxygen supplementation (0.5–1.0 L/min). For reversal, 4 mg of atipamezole per mg of medetomidine was administered intramuscularly. The boars recovered in the cage and were released once ataxia resolved. The MK group had significantly longer recovery times (mean 164 min ± 79 SD) compared to the other groups. MKB elicited longer and incomplete induction compared to the other groups (mean induction time 20 min ± 10 SD), decreasing the efficiency of the capture and increasing the risk of hyperthermia. Both ketamine-based protocols required additional ketamine intramuscularly to prolong the anesthesia after 20–40 min from induction. Agreement between the pulse oximeter and the blood gas analyzer was low, with the pulse oximeter underestimating the real values of arterial oxyhemoglobin saturation, particularly at higher readings. Mild acute respiratory acidosis (PaCO2 45–60 mmHg) and mild to moderate hypoxemia (PaO2 69–80 mmHg) occurred in most boars, regardless of the treatment group but especially in the MKB group. The acid-base status improved and hypoxemia resolved in all boars during oxygen supplementation, with the PaO2 rising above the physiological reference range (81.6–107.7 mmHg) in many individuals. MK and MKB induced safe and reliable immobilization of wild boars for at least 20 min. Supplemental oxygen delivery is recommended in order to prevent hypoxemia in wild boars immobilized with the protocols used in the present study. Long and ataxic recoveries occurred in most animals, regardless of the protocol, but especially in the MKB group.

Effect of basal forebrain somatostatin and parvalbumin neurons in propofol and isoflurane anesthesia.

AimsThe basal forebrain (BF) plays an essential role in wakefulness and cognition. Two subtypes of BF gamma‐aminobutyric acid (GABA) neurons, including somatostatin‐expressing (GABASOM) and parvalbumin‐positive (GABAParv) neurons, function differently in mediating the natural sleep–wake cycle. Since the loss of consciousness induced by general anesthesia and the natural sleep–wake cycle probably share similar mechanisms, it is important to clarify the accurate roles of these neurons in general anesthesia procedure.MethodsBased on two transgenic mouse lines expressing SOM‐IRES‐Cre and PV‐IRES‐Cre, we used a combination of genetic activation, inactivation, and chronic ablation approaches to further explore the behavioral and electroencephalography (EEG) roles of BFSOM and BFParv neurons in general anesthesia. After a single intravenous injection of propofol and the induction and recovery times of isoflurane anesthesia, the anesthesia time was compared. The changes in cortical EEG under different conditions were also compared.ResultsActivation of BF GABASOM neurons facilitates both the propofol and isoflurane anesthesia, manifesting as a longer anesthesia duration time with propofol anesthesia and a fast induction time and longer recovery time with isoflurane anesthesia. Moreover, BF GABASOM‐activated mice displayed a greater suppression of cortical electrical activity during anesthesia, showing an increase in δ power bands or a simultaneous decrease in high‐frequency power bands. However, only a limited and nuanced effect on propofol and isoflurane anesthesia was observed with the manipulated BF GABAParv neurons.ConclusionsOur results suggested that BF GABASOM neurons play a critical role in propofol and isoflurane general anesthesia, while BF GABAParv neurons appeared to have little effect.

Comparative study of hematological parameters of Colossoma macropomum anesthetized with benzocaine and eugenol by using different anticoagulants

The objective of the present study was to evaluate the action of benzocaine and eugenol over anesthesia stages and the use of three anticoagulants (ethylenediamine tetraacetic acid, sodium citrate, and sodium heparin) over hematological and biochemical parameters and erythrocyte osmotic fragility in tambaquis Colossoma macropomum. For that, fish were distributed into two experimental groups: G1: fish anesthetized with benzocaine and G2: fish anesthetized with eugenol. Induction and recovery times of anesthesia were evaluated and blood samples with different anticoagulants were collected for hematological and biochemical analysis and osmotic erythrocyte osmotic fragility. Fish anesthetized with eugenol showed a longer period of anesthesia, shorter induction time, and longer recovery time. In addition, fish anesthetized with benzocaine by using sodium citrate showed leukopenia and lymphopenia and morphological alterations when compared to the other anticoagulants. Furthermore, fish anesthetized with eugenol by using sodium citrate showed significantly lower values (P < 0.05) of hematocrit and hemoglobin when compared to other anticoagulants and there were significant differences in erythrocyte osmotic fragility between anticoagulants in fish anesthetized with eugenol. The results observed in this study indicate that eugenol is a good alternative as anesthetics for tambaquis when compared to benzocaine because of its rapid anesthesia induction and few alterations in blood parameters. In addition, the use of EDTA facilitates the erythrocyte conservation and cause few blood alterations compared to other anticoagulants.

Preliminary Report: Localized Cerebral Blood Flow Mediates the Relationship between Progesterone and Perceived Stress Symptoms among Female Collegiate Club Athletes after Mild Traumatic Brain Injury.

Female athletes are under-studied in the field of concussion research, despite evidence of higher injury prevalence and longer recovery time. Hormonal fluctuations caused by the natural menstrual cycle (MC) or hormonal contraceptive (HC) use impact both post-injury symptoms and neuroimaging findings, but the relationships among hormone, symptoms, and brain-based measures have not been jointly considered in concussion studies. In this preliminary study, we compared cerebral blood flow (CBF) measured with arterial spin labeling between concussed female club athletes 3-10 days after mild traumatic brain injury (mTBI) and demographic, HC/MC matched controls (CON). We tested whether CBF statistically mediates the relationship between progesterone serum levels and post-injury symptoms, which may support a hypothesis for progesterone's role in neuroprotection. We found a significant three-way relationship among progesterone, CBF, and perceived stress score (PSS) in the left middle temporal gyrus for the mTBI group. Higher progesterone was associated with lower (more normative) PSS, as well as higher (more normative) CBF. CBF mediates 100% of the relationship between progesterone and PSS (Sobel p value = 0.017). These findings support a hypothesis for progesterone having a neuroprotective role after concussion and highlight the importance of controlling for the effects of sex hormones in future concussion studies.

Local climate and biodiversity affect the stability of China's grasslands in response to drought

The stability of ecosystems is of great significance to the supply of ecosystem services and human well-being. Frequently occurring drought events seriously threaten the stability of terrestrial ecosystems. In particular, in grasslands with low rainfall, ecosystems are more vulnerable to drought. To date, most studies have focused on forest ecosystems, while the difference in the stability of various types of grassland ecosystems under drought is less studied. Here, we selected China's grasslands as the study system and used the standardized precipitation evapotranspiration index (SPEI) to identify drought years and drought events (2001–2015) that occurred in China. Subsequently, we used the satellite-based enhanced vegetation index (EVI) to calculate the resistance (the ability to maintain the original EVI level in a drought year), resilience (the capacity of ecosystem functioning to recover to its normal state after a drought year), and recovery time (how long an ecosystem requires to recover to its predrought EVI) of different grassland types in China from 2001 to 2015. Finally, random forest analysis was used to identify the factors affecting the spatial patterns of the three indicators of stability. The results showed that the grassland ecosystem vulnerability to drought was significantly different among grassland types. The alpine steppe and alpine meadow ecosystems located on the Qinghai-Tibet Plateau have the strongest resistance, the weakest resilience, and the longest recovery time. The meadow steppe and typical steppe ecosystems located in Inner Mongolia have the weakest resistance, the strongest resilience, and the shortest recovery time. The stability of grassland ecosystems is mainly affected by the characteristics of drought events (drought severity and duration), local climate factors (precipitation and temperature), and biodiversity. These results provide a scientific basis for taking appropriate management measures to address the impacts of future drought events on various types of grassland ecosystems.

The Effect of Virtual Reality on Anxiety and Pain in Patients Undergoing Gynecological Surgery (VRAP-G); a Randomized Controlled Trial

Background: Lack of postoperative acute pain management is associated with increased morbidity, longer recovery time, more opioid use and subsequently increased health care costs. There is increasing evidence that Virtual Reality (VR) is effective in the reduction of acute pain. Alternative methods to reduce postoperative pain and multimodal analgesia are necessary for acute postoperative pain management and to reduce opioid use and their adverse effects. The aim of this study is to explore the effect of VR on pain in the postoperative period after elective gynecological surgery. Methods and Design: The study concerns a non-blinded, single center, randomized controlled trial. Eligible women fulfilling the inclusion criteria and receive elective gynecological surgery in the Zuyderland Medical Center will be randomized for participation. The study population will be randomly divided into the intervention group (VR-group) or the standard care- group. The intervention group can choose for an immersive guided relaxation VR experience or an interactive VR experience during the pre- and postoperative period additional to the usual standard care. The participants randomized to the standard caregroup will receive only the usual standard care pre-and postoperative. The primary outcome is postoperative pain measured on a Numeric Rating Scale (NRS). A total of 30 patients have to be included in each group. This means that a total of 60 women will have to be included in this study. Secondary outcomes are; evaluating pre-and postoperative anxiety, pain catastrophizing, analgesic use, length of hospital stay between both groups and to explore tolerability, feasibility and satisfaction of VR use. Discussion: This study will provide insight as to whether in women who receive gynecological surgery, VR is an effective method to reduce postoperative pain and subsequently opioid use.

Calf and non-calf hemodynamic recovery in patients with arterial claudication: Implication for exercise training

BackgroundPrevious studies in patients with arterial claudication have focused on calf hemodynamic recovery. We hypothesized that the duration of hemodynamic recovery with TcpO2 at calf and non-calf levels would be shorter than 10 min. We analyzed the factors that influence the recovery time. MethodsWe monitored limb changes minus chest changes from rest (DROP) of transcutaneous oximetry on buttocks, thighs and calves, during and following a treadmill test (3.2 km/h; 10% grade). We calculated the time required to reach 50% (50%RT) and 10% (90%RT) of minimal DROP value (DROPm) from walking cessation. Regression analyses were used to determine the factors associated to 50%RT and 90%RT. ResultsOf the 132 patients studied, 18.2% reported isolated non-calf pain by history. Of the 792 recovery time values, only 3 (0.4%) and 23 (2.9%) were in excess of 10 min for 50%RT and for 90%RT, respectively. A weak correlation was found between each of the 792 DROPm and 50%RT (r = −0.270, p < 0.001) as well as for 90%RT (r = −0.311 p < 0.001). Lowest DROPm and BMI (but not age, sex, the use of beta-blockers, the duration of the walking period) were associated to both 50%RT and 90%RT. ConclusionAlthough recovery duration correlates significantly with the severity of ischemia of the same location, a wide discrepancy exists and the longest recovery time does not always correlate to the localization of the most severe ischemia. Non-calf ischemia should be measured when one aims at objectifying the biological effects of exercise or the effects of treatments on recovery from exercise.

Hemodynamic Response of High- and Low-Dose Dexmedetomidine of Pediatric in General Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Dexmedetomidine is a highly selective α2-adrenoceptor agonist, which is off-labelled use for pediatric sedation. However, the hemodynamic responses of dexmedetomidine remain unclear in the pediatric population. The primary objectives of this systematic review and meta-analysis were to examine the hemodynamic effects of high-dose and low-dose dexmedetomidine in pediatric patients undergoing surgery. EMBASE, MEDLINE, and CENTRAL were systematically searched from its inception until April 2019. All randomized clinical trials comparing high-dose (＞ 0.5 mcg/kg) and low-dose (≤ 0.5 mcg/ kg) dexmedetomidine in pediatric surgical patients were included, regardless of the types of surgeries. Observational studies, case series, and case reports were excluded. Four trials (n = 473) were included in this review. Our review demonstrated that high-dose dexmedetomidine was associated with lower heart rate than low-dose dexmedetomidine after intravenous bolus of dexmedetomidine (studies, 3; n = 274; mean difference [MD], -5 [-6 to -4]; P ＜ 0.0001) and during surgical stimulant (studies, 2; n = 153; MD, -11 [-13 to -9]; P ＜ 0.0001). In comparison to the low-dose dexmedetomidine, high-dose dexmedetomidine was also associated with a significant longer recovery time (studies, 3; n = 257; MD, 5.90 [1.56 to 10.23]; P = 0.008) but a lower incidence of emergence agitation (studies, 2; n = 153; odds ratio, 0.17 [0.03 to 0.95]; P = 0.040). In this meta-analysis, low-dose dexmedetomidine demonstrated better hemodynamic stability with shorter recovery time than high-dose dexmedetomidine. However, these findings need to be interpreted with caution due to limited published studies, a small sample size, and a high degree of heterogeneity.

Hemodynamic Response of High- and Low-Dose Dexmedetomidine of Pediatric in General Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Dexmedetomidine is a highly selective α2-adrenoceptor agonist, which is off-labelled use for pediatric sedation. However, the hemodynamic responses of dexmedetomidine remain unclear in the pediatric population. The primary objectives of this systematic review and meta-analysis were to examine the hemodynamic effects of high-dose and low-dose dexmedetomidine in pediatric patients undergoing surgery. EMBASE, MEDLINE, and CENTRAL were systematically searched from its inception until April 2019. All randomized clinical trials comparing high-dose (＞ 0.5 mcg/kg) and low-dose (≤ 0.5 mcg/ kg) dexmedetomidine in pediatric surgical patients were included, regardless of the types of surgeries. Observational studies, case series, and case reports were excluded. Four trials (n = 473) were included in this review. Our review demonstrated that high-dose dexmedetomidine was associated with lower heart rate than low-dose dexmedetomidine after intravenous bolus of dexmedetomidine (studies, 3; n = 274; mean difference [MD], -5 [-6 to -4]; P ＜ 0.0001) and during surgical stimulant (studies, 2; n = 153; MD, -11 [-13 to -9]; P ＜ 0.0001). In comparison to the low-dose dexmedetomidine, high-dose dexmedetomidine was also associated with a significant longer recovery time (studies, 3; n = 257; MD, 5.90 [1.56 to 10.23]; P = 0.008) but a lower incidence of emergence agitation (studies, 2; n = 153; odds ratio, 0.17 [0.03 to 0.95]; P = 0.040). In this meta-analysis, low-dose dexmedetomidine demonstrated better hemodynamic stability with shorter recovery time than high-dose dexmedetomidine. However, these findings need to be interpreted with caution due to limited published studies, a small sample size, and a high degree of heterogeneity.

Adolescents With ADHD Do Not Take Longer to Recover From Concussion.

The objective of this study was to determine whether adolescents with attention-deficit/hyperactivity disorder (ADHD) have prolonged return to school and sports following concussion compared to those without ADHD and whether medication status or concussion history is associated with recovery time. We hypothesized that having ADHD would not be associated with longer recovery time. This prospective observational cohort study, conducted between 2014 and 2019, examined concussion recovery among school sponsored athletics throughout Maine, USA. The sample included 623 adolescents, aged 14–19 years (mean = 16.3, standard deviation = 1.3 years), 43.8% girls, and 90 (14.4%) reported having ADHD. Concussions were identified by certified athletic trainers. We computed days to return to school (full time without accommodations) and days to return to sports (completed return to play protocol) following concussion. Adolescents with ADHD [median days = 7, interquartile range (IQR) = 3–13, range = 0–45] did not take longer than those without ADHD (median days = 7, IQR = 3–13, range = 0–231) to return to school (U = 22,642.0, p = 0.81, r = 0.01; log rank: = 0.059, p = 0.81). Adolescents with ADHD (median days = 14, IQR = 10–20, range = 2–80) did not take longer than those without ADHD (median days = 15, IQR = 10–21, range = 1–210) to return to sports (U = 20,295.0, p = 0.38, r = 0.04; log rank: = 0.511, p = 0.48). Medication status and concussion history were not associated with longer recovery times. Adolescents with ADHD did not take longer to functionally recover following concussion. Recovery times did not differ based on whether adolescents with ADHD reported taking medication to treat their ADHD or whether they reported a prior history of concussion.

Modulation of Synaptic Plasticity by Vibratory Training in Young and Old Mice.

In the past 40 years, scientific research has shown how Whole Body Vibration concept represents a strong stimulus for the whole organism. Low (<30 Hz), medium (30–80 Hz), and high (>80 Hz) frequency vibrations can have both positive and negative effects, depending on the oscillation type and duration of exposure to which the body is subjected. However, very little is known about the effects of vibratory training on the brain. In this regard, we verified whether three vibratory training protocols, differing in terms of vibration frequency and exposure time to vibration, could modulate synaptic plasticity in an experimental mouse model, by extracellular recordings in vitro in hippocampal slices of mice of 4 and 24 months old. Our results showed that vibratory training can modulate synaptic plasticity differently, depending on the protocol used, and that the best effects are related to the training protocol characterized by a low vibration frequency and a longer recovery time. Future studies will aim to understand the brain responses to various types of vibratory training and to explore the underlying mechanisms, also evaluating the presence of any structural and functional changes due to vibratory training.

Radiological risk indicators for persistent postoperative morbidity after third molar removal.

Although panoramic radiographs are extensively studied for diagnosis and preoperative planning in third molar surgery, research on the predictive value of this radiographic information regarding the postoperative recovery of patients remains underexploited. This prospective cohort study aimed to assess the potential relationship between radiologic risk indicators and persistent postoperative morbidity, in 1009 patients undergoing 2825 third molar extractions in context of the M3BE study. Two observers evaluated ten radiographic parameters: vertical and horizontal eruption status, third molar orientation, surgical difficulty, nerve relation, maxillary sinus relation, presence of periapical and pericoronal radiolucencies, caries, and third or second molar resorption. Patients' postoperative recovery was recorded 3 and 10days after surgery. Univariate logistic regression was performed to assess potential associations between radiographic risk indicators and persistent postoperative morbidity. Deep impactions were significantly associated with the persistence of postoperative pain, trismus and swelling until 10days after surgery, prolonged need for pain medication, and the inability to resume daily activities and work/studies. Pericoronal radiolucencies and resorption were significantly associated with persistent morbidity and a longer recovery time, whereas caries and periapical lesions were linked to a shorter recovery time. Based on the results of this study, clinicians may better inform patients at risk for persistent postoperative discomfort according to what was preoperatively diagnosed on the panoramic radiograph. Preoperative panoramic radiographs contain information about patients at risk of prolonged recovery after third molar removal. Several risk indicators for persistent postoperative morbidity were identified.

Assessing temporal responsiveness of primary stimulated neurons in auditory brainstem and cochlear implant users

The reasons why clinical outcomes with auditory brainstem implants (ABIs) are generally poorer than with cochlear implants (CIs) are still somewhat elusive. Prior work has focused on differences in processing of spectral information due to possibly poorer tonotopic representation and higher channel interaction with ABIs than with CIs. In contrast, this study examines the hypothesis that a potential contributing reason for poor speech perception in ABI users may be the relative lack of temporal responsiveness of the primary neurons that are stimulated by the ABI. The cochlear nucleus, the site of ABI stimulation, consists of different neuron types, most of which have much more complex responses than the auditory nerve neurons stimulated by a CI. Temporal responsiveness of primary stimulated neurons was assessed in a group of ABI and CI users by measuring recovery of electrically evoked compound action potentials (ECAPs) from single-pulse forward masking. Slower ECAP recovery tended to be associated with poorer hearing outcomes in both groups. ABI subjects with the longest recovery time had no speech understanding or even no hearing sensation with their ABI device; speech perception for the one CI outlier with long ECAP recovery time was well below average. To the extent that ECAP recovery measures reveal temporal properties of the primary neurons that receive direct stimulation form neural prosthesis devices, they may provide a physiological underpinning for clinical outcomes of auditory implants. ECAP recovery measures may be used to determine which portions of the cochlear nucleus to stimulate, and possibly allow us to enhance the stimulation paradigms.

Reconstruction of anterior frontal wall and contours defects using bone substitute

Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased surgical time, reabsorption, blood loss, and longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate, hydroxyapatite, titanium, or porous polyethylene, are expected to have optimal properties, including easy adaptation, biocompatibility, ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant should be easily shaped and positioned, allowing easy tissue growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally with different types of materials. However, this procedure is very expensive with various infection rates depending on the kind of material used and on the chemicophysical composition of the implant. Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an alloplastic biphasic material, composed of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the fronto-orbital area. Conclusion: The patient was first hospitalized as the result of a serious craniofacial trauma. One year after the first emergency cranio-orbital reconstructive operation, a marked deformity of the frontal region appeared with a “grid effect” due to the inadequate plate-bony fixation of the fractures applied during the first bony recomposition and because it was not as rigid as it should have been . A secondary surgery for deformity correction was performed. The hardware was totally removed and the bony deformity smoothed, reshaped, covered and filled using Cerament® Bone Void Filler, a biomaterial. The patient recovered with a satisfactory cranium-forehead shape, no complications, and complete disappearance of a frowning look of the fronto-orbital region. Recently, increased use of bone substitutes in the reconstruction of bone defects has been fuelled by donor site complications associated with autologous bone harvesting. Cerament® BoneVoid Filler is a biphasic and injectable bone substitute that has a highly compressive strength and the ability to promote cancellous bone healing