Post-intervention Day Research Articles

In Vivo Imaging of Acute Hindlimb Ischaemia in Rat Model: A Pre-Clinical PET Study.

To better understand ischaemia-related molecular alterations, temporal changes in angiogenic Aminopeptidase N (APN/CD13) expression and glucose metabolism were assessed with PET using a rat model of peripheral arterial disease (PAD). The mechanical occlusion of the base of the left hindlimb triggered using a tourniquet was applied to establish the ischaemia/reperfusion injury model in Fischer-344 rats. 2-[18F]FDG and [68Ga]Ga-NOTA-c(NGR) PET imaging performed 1, 3, 5, 7, and 10 days post-ischaemia induction was followed by Western blotting and immunohistochemical staining for APN/CD13 in ischaemic and control muscle tissue extracts. Due to a cellular adaptation to hypoxia, a gradual increase in [68Ga]Ga-NOTA-c(NGR) and 2-[18F]FDG uptake was observed from post-intervention day 1 to 7 in the ischaemic hindlimbs, which was followed by a drop on day 10. Conforming pronounced angiogenic recovery, the NGR accretion of the ischaemic extremities differed significantly from the controls 5, 7, and 10 days after ischaemia induction (p ≤ 0.05), which correlated with the Western blot and immunohistochemical results. No remarkable radioactivity was depicted between the normally perfused hindlimbs of either the ischaemic or the control groups. The PET-based longitudinal assessment of angiogenesis-associated APN/CD13 expression and glucose metabolism during ischaemia may continue to broaden our knowledge on the pathophysiology of PAD.

The Effect of Hydrotherapy : Foot Soak on Lowering Blood Pressure of Preeclampsia Pregnant Women at Aura Syifa Hospital Kediri

Preeclampsia is a condition of pregnant women who tend to be high so they are at greater risk of developing hypertension. This is mostly caused by maternal age and gestational age. Preeclampsia can be treated with nonpharmacological methods, one of which is foot hydrotherapy. The study aims for knowing the influence of hydrotherapy: foot soaks against drop pressure blood on a mother pregnant with preeclampsia at Aura Syifa Hospital Kediri. Type study This use study Pre Experimental Design with design research used One Group Pretest and Posttest Design with 21 respondents with use Purposive sampling technique using sheet research instrument observation and analysis with the Wilcoxon test. Pretest and posttest analysis produce a drop in pressure blood on the first day of 0,8. Decrease pressure pre-intervention blood and post-intervention day second of 0,85. whereas descent pressure pre-intervention blood and post-intervention day third of 0,71. with a value of 0,000, which means there is an influence of foot hydrotherapy against drop pressure blood on a mother pregnant with preeclampsia at Aura Syifa Hospital Kediri. Hydrotherapy using warm water to soak the feet can dilate blood vessels, and reduce muscle tension so that blood flow becomes smooth.

Rehabilitation protocols in proximal humerus fracture management: A systematic review.

Proximal humerus fractures (PHFs) are relatively common, although optimal rehabilitation is unknown. This review aims to characterize the published rehabilitation regimens utilized for PHFs. A systematic review was performed per PRISMA guidelines, utilizing PubMed/MEDLINE, Embase, and Cochrane. All studies reporting PHF rehabilitation protocols after nonoperative management, open reduction internal fixation with a plate, or intramedullary nailing were included. Forty articles comprising 3507 patients (66% female, weighted mean age 63.5 years) were included. Substantial variability was present regardless of management. Rehabilitation modalities reported were: sling use in 34 cohorts, most commonly for three weeks; pendulum exercises in 21 cohorts, most commonly starting at post-intervention day 1; post-intervention passive range of motion (ROM) for 30 cohorts, most commonly starting at two days; active-ROM in eight cohorts, most commonly starting at three weeks; active-assisted ROM for 21 cohorts, most commonly starting at three weeks; unlimited ROM for 20 cohorts, most commonly at 4 or 6 weeks; non-weight-bearing for six cohorts, most commonly for six weeks; strengthening for 16 cohorts, most commonly at six weeks; removal of all restrictions for nine cohorts, most commonly starting at six weeks. Published rehabilitation protocols for PHFs vary considerably regardless of management. Future studies comparing methods of management need to consider the influence of postoperative rehabilitation protocol heterogeneity when aggregating data from multiple sites. IV.

Evaluation of Hematological Parameters After ESWL and Ureterorenoscopy for the Treatment of Kidney Stones

Background: Bleeding and hematuria can be a consequence of both ESWL and URS treatment.Changes in hematological parameters may be indicative of bleeding events.Objective: The aim of the present study was to explore the hematological parameters after ESWL and ureterorenoscopy for the treatment of kidney stones. Methods: A prospective study included patients (120) with verified ureterolithiasis <10 mm in the upper half of the proximal third of the ureter. Patients were divided into two groups using the random sample method for the application of active stone removal methods ESWL or URS with contact disintegration.Patients were evaluated with routine hematological, biochemical blood parameters, and non-contrast enhanced computed abdominal tomography (CT) before the procedure.Routine laboratory analyzes were performed using standard methods and included determination of the number of erythrocytes, platelets, hemoglobin, hematocrit, glucose, INR, APTTwhich were measured preintervention, the first postoperative day and six months after the intervention. Results: The preintervention hemoglobin value in patients with urolithiasis treated with URS treatment was 140 g/L (136.2–155.7), and was statistically significantly higher compared to the measurement on the first post-intervention day [137.5 g/L (127, 2–156.7) (p<0,05)], as well as in relation to the measurement after six months [139 g/L (134.2–151.7), (p<0,05).The pre-interventional hematocrit value in patients with urolithiasis treated with URS treatment was 0.42 (0.41–0.47), but it dropped statistically significantly on the measurement on the first post-intervention day to a value of 0.41 (0.38–0, 47) (p=0.003). The hematocrit value after six months was 0.44 (0.41–0.47) and was statistically significantly higher compared to the pre-intervention measurement (p=0.002), as well as compared to the measurement on the first post-intervention day (p< 0.001). The pre-intervention INR value in patients with urolithiasis treated with URS treatment was 0.90 (0.86–1.1), and on the first post-intervention day, it increased statistically significantly to a value of 0.99 (0.89–1.1), (p=0.005).The INR value after six months continued to grow to a value of 1.02 (0.96–1.2), which was statistically significantly higher compared to the INR value measured on the first post-intervention day (p<0.001), as and in relation to the INR value measured before the intervention (p=0.007).Conclusion: The results of this study, in terms of hematological parameters, showed more favorable outcomes in patients treated with ESWL compared to URS lithotripsy. Significantly lower hemoglobin values six months after URS treatment, as well as a decrease in the number of platelets on the first postoperative day, lead to the conclusion that URS lithotripsy, which represents a more aggressive method compared to ESWL, may have less favorable consequences for patients.

Laparoscopic Approach to Pancreatic Pseudocyst: A Case Report

Pancreatic Pseudocyst (PP) is a local complication due to rupture of the pancreatic duct in acute or chronic pancreatitis, trauma or obstruction of the pancreatic duct. Acute forms usually resolve spontaneously in more than 40% of cases and chronic forms usually do not disappear and are at higher risk of complications. They can be drained by surgical, laparoscopic, percutaneous and endoscopic methods. Percutaneous drainage may lead to an external pancreatic fistula and is not preferred Endoscopic internal drainage of pseudocysts has been shown to be effective and is less invasive compared to open surgery . We present a 70 year old male with a history of several episodes of acute pancreatitis with subsequent residual pseudocyst. Initially, an EUS-FNA/ERCP is performed with aspiration of the pseudocyst. Due to the subsequent recurrence months later, it was decided to consider a laparoscopic approach, to solve the recurrence, performing a laparoscopic cystogastrostomy. Postoperative period was uneventful and was discharged on the seventh post-intervention day.

A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework.

Introduction: With an increasingly ageing population, there is a growing impact of fragility hip fracture on the healthcare system and on society as a whole. Oral and injectable analgesics are often insufficient whilst traction and regional blocks do not allow patients to be discharged easily. While the conventional approach of ultrasound-guided anterior hip pericapsular neurolysis can help a lot of inoperable hip fracture patients to relieve their fracture pain and facilitate subsequent nursing care, enormous technical challenges are encountered in some cases. In this retrospective case study, we evaluated the overall pain and functional outcomes of our modified approach of anterior hip pericapsular neurolysis for inoperable hip fractures using the IDEAL framework. Method: This retrospective case series studied patients with acute inoperable hip fracture who received the modified approach of anterior hip pericapsular neurolysis from January 2018 to June 2019 according to the IDEAL recommendations. The modified approach consisted of pericapsular nerve group (PENG) injection, iliopsoas plane infiltration, and the sagittal approach of obturator nerve articular branches (ONAB) injection. Subsequent alcohol neurolysis would be performed in the same setting if there were positive diagnostic blocks. Assessments were carried out on post-intervention day 5. The primary outcome was pain intensity during hip flexion at 80 degrees in the recumbent position and during gentle hip internal and external rotation using an appropriate pain scoring tool. The secondary outcomes were the range of tolerable hip flexion and occurrence of any lower limb neurological deficit because of the procedure. Interim outcomes were also briefly evaluated. Results: Among the 74 patients who were reviewed in the study period, the median dynamic pain at hip flexion 80° (p < 0.001) and on gentle hip external and internal rotation (p < 0.001) was significantly reduced from a composite score of 3 (severe pain) to 1 (mild pain) on post-intervention day 5 after the modified approach of hip neurolysis. This translated to 72% of patients achieving satisfactory pain control, which was defined as a composite pain score of ≤1 on hip flexion at 80°. Functionally, the mean range of tolerable hip flexion significantly improved from 39.7° at baseline to 74° on post-intervention day 5 (p < 0.001). Transient and reversible hypotension was seen in about 10% of the patients. No other major procedural adverse event was noted. Interim follow-up at 4–6 months post-intervention revealed that more than 95% of patients continued to have satisfactory dynamic pain control (i.e., composite pain score ≤ 1). According to the IDEAL classification, this study could be ranked as stage 2a (development). Conclusions: Our findings suggested that anterior hip pericapsular neurolysis using a modified approach could offer consistent and satisfactory analgesic and functional benefits to a majority of patients with inoperable hip fractures during the interim of the fracture healing process, and it was potentially safer than the conventional approach. This technique might have achieved its readiness to proceed to the next stage of research according to the IDEAL framework.

Predictors of Renal Recovery among Patients of Obstructive Urolithiasis with Renal FailureA Prospective Observational Study

Introduction: Timely intervention in patients of obstructive uropathy secondary to renal and /or ureteric stones can reduce the morbidity and mortality in such patients. Aim: To determine the factors predicting recovery in patients of urinary stones and obstructive uropathy. Materials and Methods: This prospective observational study was conducted at Shri Mahant Inderesh Hospital, Dehradun, Uttrakhand, India, between December 2018 and June 2020. All patients with renal failure (serum creatinine &gt;1.5 mg/dL) secondary to urinary stones presenting to the Emergency Department were included in the study. Baseline demographic data, clinical, haematological, biochemical and microbiological parameters were recorded at presentation and after Double J Stent (DJS) insertion at postintervention day 1, 3 and 7. Total 40 patients were divided into two groups i.e, recovered (n=25) and non recovered (n=15) groups. Receiver Operating Characteristic (ROC) curves was used to obtain optimal threshold duration of illness, the values of serum creatinine, serum urea, haemoglobin and serum potassium, and time to nadir creatinine for predicting renal recovery. The graphs were made using both Microsoft excel and SPSS software. Results: Out of total 40 pateints, 29 were males and 11 were females. The mean duration of symptoms in the recovered and non recovered groups was 4.64 and 15.53 days, respectively (p-value=0.001). Thirteen out of 15 patients (86.6%) in the non recovered group and 10 out of 25 (40%) in the recovered group had pre-existing co-morbidities (p-value=0.004). Postobstructive diuresis was present in 84% patients in the recovered and 46.6% in the non recovered group (p-value=0.016). The nadir serum creatinine level was 1.26 mg/dL in recovered as compared to 6.08 mg/dL in the non recovered patients (p-value=0.001). The ROC curves were plotted for various parameters in order to find the prognostic accuracy in predicting recovery. The best criteria were symptom duration ≤6 days, serum creatinine at presentation ≤6.2 mg/dL, serum potassium ≤5.5 mg/dL, and haemoglobin level &gt;9.4 gm/dL. Conclusion: Short duration of symptoms (≤6 days), lower serum creatinine levels (≤6.2 mg/dL), lower serum potassium levels (≤5.5 mg/dL), and higher haemoglobin level (&gt;9.4 gm/dL) were found to predict a greater chance of recovery. These factors can help in formulating treatment protocols for early intervention leading to a better prognosis in this subgroup of patients.

Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes.

We aimed to analyze the technical success rate of manual percutaneous aspiration thrombectomy (PAT) in patients with peripheral arterial thromboembolism as a complication of infrainguinal percutaneous transluminal angioplasty (PTA) and we sought to evaluate the 30-day postintervention clinical outcome. We retrospectively identified 29patients (men/women, 18/11; mean age, 74 years) who underwent infrainguinal PAT to treat thromboembolic complications of infrainguinal PTA. Primary and secondary technical successes were defined as residual stenosis of < 50 % of the vessel diameter after PAT alone and PAT with additional PTA, respectively. Clinical outcome parameters (e. g., amputation, need for further intervention) were evaluated during the first 30 days after intervention. The primary and secondary technical success rates were 58.6 % (17/29) and 79.3 % (23/29), respectively. Clinical outcome data were available for 93.1 % (27/29) of patients. No further intervention was required within 30 days in 81.5 % (22/27) of patients. Four patients underwent minor amputations owing to preexisting ulcerations (Rutherford Category 5), and no patients underwent major amputations (Rutherford Category 6). Revascularization of the previously treated vessel segment with PTA was necessary on the first postintervention day in one patient. Manual PAT, with PTA if needed, has a good technical success rate and satisfactory early clinical outcome in patients with iatrogenic thromboembolic complications after infrainguinal PTA. · Manual PAT is a possible first-choice treatment of infrainguinal PTA-induced acute thromboembolism.. · Performing additional PTA increases the success rate of manual PAT.. · Unlike catheter-directed intraarterial lysis, manual PAT carries no risk of bleeding.. · Schicho A, Bäumler W, Verloh N et al. Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes. Fortschr Röntgenstr 2022; 194: 291 - 295.

In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction

ObjectiveIn-stent restenosis (ISR) and stent compression (SC) are problems encountered after stenting for chronic iliofemoral venous obstruction that are responsible for a majority of reinterventions. However, characteristics of ISR and SC, in addition to outcomes after reintervention, have not been explored in detail and represent the focus of this study. MethodsA retrospective analysis of contemporaneously entered electronic medical record data on 578 limbs/patients with initial unilateral iliofemoral venous stents placed from 2014 to 2018 was performed. ISR was estimated from stent and flow channel diameters measured using duplex ultrasound. SC was estimated from rated stent diameter and actual stent diameter on duplex ultrasound. Characteristics evaluated included onset of ISR/SC after stent placement and progression over time. Analysis was performed to evaluate risk factors for the development of ISR and SC. Outcomes after reintervention for ISR/SC were also appraised. ResultsA total of 578 limbs underwent stenting for stenotic lesions (nonthrombotic iliac vein lesion/post-thrombotic syndrome). ISR was noted in 27% of limbs on post-intervention day 1. The prevalence of ISR increased to 74% by 3 months and stabilized thereafter. SC was noted in 80% of limbs on day 1 and plateaued. Of the variables evaluated as potential risk factors for ISR, intravascular ultrasound determined stent inflow luminal area and shear rate were found to be significant. For SC, asymmetric stent sizing was a significant risk factor. Over a median follow-up of 24 months, 95 of 578 (16.4%) limbs underwent reintervention for ISR, SC, or a combination. The median time to reintervention was 11 months. There was no statistically significant difference in the degree of ISR/SC among patients who underwent reintervention vs those who did not (P > .05). However, there was a statistically significant difference in the grade of swelling (P = .006) and visual analog scale pain scores (P < .0001) between those who underwent reintervention and those who did not. Primary, primary assisted, and secondary patencies at 60 months were 70%, 98%, and 84% after reintervention for ISR and 70%, 99%, and 84% for SC, respectively. ConclusionsAlthough ISR and SC are both common after stenting for chronic iliofemoral venous obstruction, neither are relentlessly progressive. Indication for reintervention must be a recurrence of symptoms with impairment of quality of life and not the percentage of ISR or degree of SC. After reintervention good outcomes can be expected both in terms of clinical improvement and stent patency. Further study of the impact of shear rate on stent flow is required to help reduce the incidence of ISR.

Higher Caloric Exposure in Critically Ill Patients Transiently Accelerates Thyroid Hormone Activation.

The inflammatory response of critical illness is accompanied by nonthyroidal illness syndrome (NTIS). Feeding has been shown to attenuate this process, but this has not been explored prospectively over time in critically ill patients. To explore the impact of calorie exposure on NTIS over time in critically ill patients. Mechanically ventilated patients with systemic inflammatory response syndrome (SIRS) were randomized to receive either 100% or 40% of their estimated caloric needs (ECN). Thyroid hormones were measured daily for 7 days or until intensive care unit discharge or death. Mixed level regression modeling was used to explore the effect of randomization group on plasma triiodothyronine (T3), reverse triiodothyronine (rT3), thyroxine (T4), and thyroid stimulating hormone (TSH), as well as the T3/rT3 ratio. Thirty-five participants (n=19 in 100% ECN; n=16 in 40% ECN) were recruited. Adjusting for group differences in baseline T3/rT3 ratio, the parameters defining the fitted curves (intercept, linear effect of study day, and quadratic effect of study day) differed by randomization group (P = 0.001, P = 0.01, and P = 0.02 respectively). Plots of the fitted curves revealed that participants in the 100% ECN group had a 54% higher T3/rT3 ratio on postintervention day 1 compared with the 40% ECN group, a difference which attenuated over time. This was driven by a 23% higher plasma T3 and 10% lower plasma rT3 levels on postintervention 1. Higher caloric exposure in NTIS patients transiently attenuates the drop of the plasma T3/rT3 ratio, an effect that is minimized and finally lost over the following 3 days of continued higher caloric exposure.

Compartmental-modelling-based measurement of murine glomerular filtration rate using 18F-fluoride PET/CT

Accurate measurement of glomerular filtration rate (GFR) is essential for optimal decision making in many clinical settings of renal failure. We aimed to show that GFR can be accurately measured using compartmental tracer kinetic analysis of 18F-fluoride dynamic PET/CT. Twenty-three male Sprague-Dawley rats of three experimental groups (cyclosporine-administered [n = 8], unilaterally nephrectomized [n = 8], and control [n = 7]) underwent simultaneous 18F-fluoride dynamic PET/CT and reference 51Cr-EDTA GFR (GFRCrEDTA) test at day 0 and post-intervention day 3. 18F-fluoride PET GFR (GFRF-PET) was calculated by multiplying the influx rate and functional kidney volume in a single-tissue-compartmental kinetic model. Within-test repeatability and between-test agreement were evaluated by intraclass correlation coefficient (ICC) and Bland-Altman analysis. In the control group, repeatability of GFRF-PET was excellent (ICC = 0.9901, repeatability coefficient = 12.5%). GFRF-PET significantly decreased in the renally impaired rats in accordance with respective GFRCrEDTA changes. In the pooled population, GFRF-PET agreed well with GFRCrEDTA with minimal bias (−2.4%) and narrow 95% limits of agreement (−25.0% to 20.1%). These data suggest that the single-compartmental kinetic analysis of 18F-fluoride dynamic PET/CT is an accurate method for GFR measurement. Further studies in humans are warranted.

In-Stent Restenosis After Iliocaval Stenting–Characteristics and Outcomes

With increasing use of iliocaval stenting, complications of such stenting have also become more common. In-stent restenosis (ISR), an outcome that is responsible for a majority of reinterventions, is one that has not been studied in detail. Characteristics of ISR in addition to outcomes after reintervention are evaluated. A retrospective review of contemporaneously entered electronic medical record data on 372 limbs with initial unilateral iliocaval stents (247 left and 125 right) placed during a 3-year period from 2015 to 2017 was performed. ISR was estimated from stent and flow channel diameters measured using duplex ultrasound. Characteristics evaluated included onset of ISR after stent placement and progression over time. Regression analysis was performed to evaluate risk factors for development of ISR. Outcomes after reintervention for ISR were also appraised. Kaplan-Meier analysis was used to assess stent patency afater intervention; paired t-test was used to examine preintervention and postintervention outcomes. There were 361 limbs that underwent stenting for stenotic lesions, whereas 11 underwent stenting for chronic native vein occlusions. ISR was noted as early as postintervention day 1. It progressed to a maximal value by 6 months and stabilized thereafter. The overall median ISR across stented common femoral, external iliac, and common iliac segments at 12 months was 43.75%. The segment most commonly affected by ISR was the external iliac vein (77.5%). Up to 89% of stents can have some degree of ISR at 12 months. Variables evaluated as predictors for ISR included age, sex, thrombophilia, thrombotic or nonthrombotic lesion, inflow, stent compression, shear rate, and flow rate. Of these, only lack of stent compression was a significant predictor of ISR at 6 and 12 months. During a median follow-up of 13 months, 50 of 372 (13%) limbs underwent reintervention for ISR and 12 (3%) underwent reintervention for stent occlusion (8 acute [<30 days] and 4 chronic [>30 days]). After reintervention, the Venous Clinical Severity Score improved from 6 to 4 for the ISR cohort (P < .001). Median primary, primary assisted, and secondary patencies after reintervention for ISR were 37, 38, and 17 months, respectively. ISR occurs early after iliocaval stenting but stabilizes around 6 months. Progression of ISR to stent occlusion is rare. No statistically significant, modifiable predictor for ISR was noted. After reintervention for ISR, good clinical outcomes and stent patencies can be expected.

In Vivo Second Harmonic Generation Microscopy as a Novel Assessment of Nerve Damage

Grant support received from: 2017 AFSH AFSH Basic Science Grant Royalty: Smith and Nephew (Hausman) Receipt of Intellectual Property Rights: Checkpoint Surgical (Hausman) Consulting Fee: Checkpoint Surgical (Hausman) Speaker's Bureau: Skeletal Dynamics, TriMed (Hausman) Ownership Interest: Checkpoint Surgical, NDI Medical (Hausman) We hypothesize second harmonic-generation (SHG) microscopy can be utilized as an in vivo, real-time imaging modality of peripheral nerve structural damage due to a stretch injury. Furthermore, we seek to validate these findings by using intraoperative nerve stimulation as a functional assessment of nerve damage. Following IACUC approval, Sprague-Dawley rats (N=5) were anesthetized and micro dissection was performed to separate median nerves from surrounding tissue. A biphasic handheld surgical nerve stimulator was used to probe median nerves before and after intervention to assess nerve function by monitoring for a twitch of the paw. 1cm of the right median nerve was placed in a custom-made stretch applicator and a 20% strain was applied to the nerve for 5 minutes, simulating a high-strain injury (HS). Left median nerves served as a sham control (SC), being treated exactly the same with the exception of applying a strain. Subjects were then brought to the microscopy core facility where they were imaged in vivo using a multiphoton microscope. In vivo SHG images of both HS and SC nerves demonstrated the ability to visualize epineurial collagen fibers. All (5 of 5) HS nerves at day 0 demonstrated undulating wavy fibers with general disorganization and large amounts of fiber crossing (Figure 46-1B). Conversely, 5 of 5 SC nerves at day 0 demonstrated intact, parallel, linearly organized collagen structure with no evidence of crossing fibers (Figure 46-1A). At 84 days postinjury, 4/5 HS nerves demonstrated complete recovery validated by linearly organized, parallel collagen fibers (Figure 46-1D). Nerve stimulation data corroborated with patterns of collagen structure observed via SHG microscopy. All nerves (HS and SC) required the same baseline stimulation value of 0.025 μC to produce a twitch of the paw. Following injury, HS nerves required a mean increase of 0.135 μC to induce a twitch (P = .0053) (Figure 46-2A) while SC nerves required no increase in stimulation. Comparing day 0 postintervention values with day 84 values, 4 of 5 HS nerves demonstrated complete recovery of function with a mean recovery of –0.12 μC (P = .0283) (Figure 46-2B). No SC nerves required an increase in stimulation at post-sham day 0 and day 84 conditions. •In vivo SHG microscopy provides high-resolution real-time visual assessment of nerve damage.•Intraoperative nerve stimulation is a novel and accurate functional assessment of nerve damage in animal models.•Epineurial collagen organization may be a reliable marker of nerve health and function.Figure 46-2AB(A) Day 0 intraoperative nerve stimulation data indicates no change in pre- and postsham values in SC nerves. A statistically significant increase in stimulation was observed between pre- and poststretch values in HS nerves. (B) A comparison of intraoperative nerve stimulation values at postintervention day 0 and at day 84 indicates a statistically significant recovery of stimulation values in HS nerves. No change was observed in SC nerves.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) This research was supported by a Basic Science Grant from the American Foundation for Surgery of the Hand.

A Saturated Approach to the Four-Phase, Brain-Based Simulation Framework for TeamSTEPPS® in a Pediatric Medicine Unit.

Introduction:Although many organizations have reported successful outcomes as a result of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), implementation can be challenging, with its share of administrative obstacles and lack of research that shows observable change in practice.Methods:This quantitative, pretest/posttest design pilot research used a combination of classroom simulation-based instruction and in situ simulation in a Pediatrics department in an urban academic center. All personnel with direct patient care responsibilities (n = 547) were trained in TeamSTEPPS in an 8-week period. TeamSTEPPS course knowledge scores were compared pretraining to posttraining using the Wilcoxon rank-sum test. The performance of two-day and overnight shift teams, pre- and postintervention was assessed using the TeamSTEPPS Team Performance Observation Tool.Results:TeamSTEPPS course knowledge improved from the beginning of the course to completion with median scores of 16 and 19, respectively (P < 0.001). Both day and evening postintervention groups demonstrated greater team performance scores than their control counterparts. Specifically, postintervention day shift team showed the greatest improvement and demonstrated more TeamSTEPPS behaviors.Conclusion:This pilot study involving 1 department in an urban hospital showed that TeamSTEPPS knowledge and performance could be improved to increase patient safety and reduce medical errors. However, teams need to be trained within a shorter period so they can apply a shared-model of teamwork and communication. Leaders and educators throughout the department must also reinforce the behaviors and include them in every education intervention.

25-gauge vitrectomy and gas for the management of rhegmatogenous retinal detachment.

To evaluate the anatomical and functional results in patients with rhegmatogenous retinal detachment (RRD) who underwent 25-gauge pars plana vitrectomy (PPV) with gas tamponade. A retrospective evaluation of 126 eyes of 126 patients (79 men, 47 women) with RRD who underwent 25-gauge PPV with gas tamponade (13% C3F8 in 87 eyes, 20% SF6 in 39 eyes). 113 patients (89.7%), were operated on under local anaesthesia, 13 patients (10.3%) under general anaesthesia. Macula was detached in 85 eyes (67.5%). 53 eyes had pseudophakic RRD, 73 eyes were phakic. Anatomical success of the primary intervention, change in best corrected visual acuity (BCVA) and incidence of complications were assessed. An average follow-up period is 7.2 months (6-15). With single operation, retinal attachment was achieved in 125 eyes (99.2%); the final anatomical success was 100%. The initial mean BCVA was 0.89 logMar (2.00 to 0.00); at the end of the follow-up period, it improved to 0.23logMAR (1.00 to -0.10), P < 0,0001. During the first post-intervention day, hypotony of the eye below 10 mmHg was observed in 1 patient (0.8%); on the contrary, intraocular pressure was temporarily increased to 25 mmHg and more in 36 patients (28.6%). The surgical treatment of RRD using 25-gauge PPV with expansive gas tamponade renders excellent anatomical results and improvement in BCVA. The incidence of complications and necessity of sclerotomy suturing are low.

Tissue sublimation follow transarterial embolization of a follicular nodular hyperplasia of the liver\u2014report of a case

BackgroundFollicular nodular hyperplasia (FNH) is a common benign liver tumor for which conservative management is indicated. Surgical or interventional management is indicated in symptomatic cases. Transarterial embolization (TAE) has been extensively used to manage unresectable liver tumors. Sublimation describes a change of physical state from solid to gas. Hepatic tissue sublimation following TAE has so far not been reported in medical literature.Case presentationA 30 year - old male patient presenting with pain to the upper abdomen due to a large FNH was managed with TAE. Routine radiographic control on post-intervention day one was within normal limits. Imaging due to right upper quadrant pain with fever and elevated inflammatory markers and liver enzymes on day two after TAE revealed a marked reduction of the FNH accompanied by the presence of a large volume of gas collection without signs of abscess formation. This change of state from solid to gas without sign of abscess formation within 2 days after TAE was described as hepatic tissue sublimation. The patient was managed conservatively and discharge 12 days after TAE.ConclusionTissue sublimation has hardly been reported in medical literature. This to the best of our knowledge is the first documented case of hepatic tissue sublimation following TAE.

Effects of Auricular Acupressure on Improving the Sleep Quality of Puerperae

Puerperae exhibit generally poor sleep quality. Previous studies have shown auricular acupressure as effective in improving the sleep problems of nurses, college students, and elderly indigenous Taiwanese women. However, no study has yet examined the effectiveness of auricular acupressure in improving the sleep quality of postpartum women. To explore the efficacy of auricular acupressure (AA) on puerperae who were affected by sleep disturbance. A prospective quasi-experimental design was used and 60 puerperae with insomnia who scored at least 5 on the Chinese of version of the Pittsburgh Sleep Quality Index (CPSQI) were recruited at one postpartum centre (a "doing-the-month" care centre) in northern Taiwan. The experimental group (n=30) received pasted auricular magnetic beads and acupressure on the Shenmen, Xin, and Shen points. The control group (n=30) received general nursing directions about insomnia only. All participants were assessed using the CPSQI prior to the intervention and on the 21st post-intervention day. The intervention effects were analysed using the Generalized Estimating Equation (GEE). After three weeks of the AA intervention, the mean global PSQI score had decreased significantly more in the experimental group than in the control group (p<.05). Furthermore, experimental-group participants reported better sleep quality (p<.05), longer total sleep time (p<.001) and lower sleep disturbance (p<.05) than their control-group peers. The present pilot study found complementary AA to be an effective intervention for treating puerperae with insomnia. This non-pharmacological and nonintrusive intervention for improving sleep disturbance in puerperae promotes the quality of sleep.

Effect of Mindfulness Meditation on the Quality of Life of Alcoholics in a Selected De-addiction Centre at Mangalore, Karnataka

The aim of the study was to determine the effect of Mindfulness Meditation on the Quality of Life (QOL) of alcoholics. A quantitative experimental evaluative approach was adapted and pre-experimental research design (one group pre-test – post-test design) was used. The sample consisting of 30 alcoholics in the selected de-addiction centre chosen by purposive sampling technique. Tools used were baseline proforma, QOL and Mindfulness Meditation skills rating scales. The data were analysed using paired ‘t’ test, ANOVA for repeated measures, Karl Pearson co-relation co-efficient and chi-square. The study revealed that mean post-test QOL score (101.57±13.7) was greater than the mean pre-test QOL score (121.70±10.02). There was a significant difference between the preintervention and post-intervention QOL scores (t 29=8.718; p&lt;0.05) . The mean of 15th day of Mindfulness Meditation Skill score (68.13±4.0) was greater than the mean of 5th day (55.53±7.06) and 10th day (60.80±4.7) scores. There was a significant difference between the three different days of assessment (F=89.80, p&lt;0.05). This indicates that the skill in Mindfulness Meditation increases when the number of days of practice progresses. There was a moderate positive correlation between post-interventional QOL and 15th day Mindfulness Meditation skill level (r=0.57). This indicates that there is a significant relation between post-intervention QOL score and 15th day Mindfulness Meditation Skill scores. There was no association between pre-intervention QOL and selected baseline characteristics. The result showed that Mindfulness Meditation had a statistically significant positive effect on the QOL of the alcoholics.

English

We are reporting the case of a 64-year-old woman with acute inferior ST elevation myocardial infarction with right ventricular infarction. She underwent primary angiography which revealed total occlusion of distal right coronary artery (RCA) by thrombus. Three runs of aspiration were performed and the thrombus was aspirated from RCA without additional ballooning or stenting. Postaspiration angiography revealed normal TIMI-3 flow down with the resolution of the thrombus and a residual noncritical trombus was seen also. She was started on glycoprotein (GP) IIb-IIIa inhibitor tirofiban for 48 h. A new angiography performed on the 4th post-intervention day and TIMI-3 flow down was seen in RCA with complete disappearance of the residual thrombus. &nbsp; Key words:&nbsp;Intracoronary thrombus, acute myocardial infarction, thrombus aspiration.

Intermittent theta burst stimulation over ipsilesional primary motor cortex of subacute ischemic stroke patients: A pilot study

BackgroundWe demonstrated that prolonged transcranial magnetic intermittent theta burst stimulation (iTBS, 1200pulses/session=iTBS1200) produces longer-lasting facilitation in corticospinal excitability than ordinary form of iTBS in healthy subjects. ObjectiveHere we show the safety and small-scale efficacy of iTBS1200 over ipsilesional primary motor cortex (M1) in subacute stroke patients. MethodsTwelve patients with first-time, subacute ischemic stroke of the middle cerebral artery were randomized into two groups that received 10 daily-sessions of either iTBS1200 or sham stimulation (n=6/group) over ipsilesional M1 hand region in addition to medical and rehabilitation treatments. The primary outcome measures were safety and tolerability. The secondary outcome measures included the National Institute of Health Stroke Scale (NIHSS), Upper Extremity Fugl-Meyer Test (UE-FMT), Action Research Arm Test (ARAT), active motor thresholds (aMTs)/motor-evoked potentials (MEPs) from the extensor carpi radialis (ECR), and magnetoencephalography on post-intervention day 1 and post-stroke day 60. ResultsiTBS or sham stimulation was well tolerated by all patients without seizures or significant adverse effects. Compared with the matched controls, the iTBS group showed measurable improvements in the NIHSS and the proximal UE-FMT scores on post-intervention day 1 and post-stroke day 60. Nevertheless, the hand ARAT scores, aMT and MEPs from the paretic ECR were not different between groups. Post-movement beta synchronization increased over iTBS-conditioned M1 on post-intervention day 1 in testable patients. ConclusionsRepetitive sessions of iTBS1200 over ipsilesional M1 of subacute stroke patients are safe and the potential benefits encourage a larger trial to determine the efficacy in stroke patients. (ClinicalTrials.gov: NCT-01323881).