Reduce Rehabilitation Time Research Articles

Comparing the clinical efficacy of prostate enucleation by the Millin method and enucleation performed using a holmium laser (HoLEP) with a prostate volume more than 80 cm3

Purpose of the study was to compare of the average long-term results of classical prostate enucleation using the Millin method and enucleation performed using a holmium laser (HoLEP). Patients and methods. This study, conducted on the basis of the Endocrinology Research Center of the Ministry of Health of the Russian Federation, included 100 patients operated on for obstruction of the prostatic part of the urethra over the period 2020–2023. The main indication for surgery was benign prostatic hyperplasia. The selection criterion for patients was a prostate volume of more than 80 cm3. The patients were divided into 2 groups depending on the intervention performed: in the 1st group Millin surgery was performed (n = 50), in group 2n laser enucleation of the prostate was done (n = 50). The data obtained during the operation in the early postoperative period, as well as the results of postoperative follow-up of patients were analyzed. Results. In the mid-term period, 4–6 months after surgery, patients from both groups were observed to improve their condition and reduce complaints of dysuric phenomena. The results were obtained illustrating a shorter inpatient stay for patients who underwent HoLEP (4.3 ± 0.6 days versus 10.0 ± 2.4 during Millin surgery), which is correspondingly associated with a faster recovery after this intervention compared with the classic one. A statistically significant (p-value < 0.05) problem of patients from the HoLEP group was urethral stricture, which occurred in 6 % of the subjects from this group and did not occur in the Millin surgery group. In fact, scarring of the bladder neck was more commonly obserbed (10 % vs. 8 %) in the Millin surgery group. However, these complications were not more than 10 %. As a result of the study, there was no statistically significant effect of using HoLEP on erectile dysfunction in patients, which suggests the potential of this technique for a lower incidence of worsening erectile dysfunction compared with open intervention. Conclusions. HoLEP is a safe method of prostate enucleation, applicable for its large volume, in particular, up to 80 cm3. This procedure is an alternative to classical open surgery, and can be recommended for patients with polymorbidity to reduce the risk of perioperative complications and reduce rehabilitation time. Millin surgery is also a reliable treatment method with high sensitivity to the detection of cellular atypia and a large volume of cytoreduction. The decision on the surgical procedure used must be made individually for each patient.

The central-peripheral coupling effect of ocular acupuncture kinesitherapy in post-stroke dyskinesia: A functional neuroimaging and neurotic electrophysiology study protocol.

BackgroundDyskinesia is a common manifestation after stroke. Motor functional rehabilitation after stroke is of great significance to the maintenance of national health. Ocular Acupuncture Kinesitherapy (OAKT) can repair nerve injuries, improve motor function, reduce rehabilitation time, and promote dyskinesia recovery after stroke. The mechanism, however, remains a mystery, necessitating urgent research. The M1-thalamus-spinal cord neural signaling pathway is linked to limb motor function. Bold-fMRI can represent the cerebral functional state, and TMS-MEP is of certain practical utility for assessing motor neural function and prognosis. Combining fMRI scanning with TMS-MEP detection is predicted to advance brain-spinal cord regulation and muscle response linkage control mechanism research, as well as completely investigate the central-peripheral coupling effect of Ocular Acupuncture Kinesitherapy on dyskinesia after stroke (PSD).MethodsThis is a prospective functional neuroimaging and neurotic electrophysiological study with a case-control design between the PSD with the HC groups and a randomized controlled design within the 3 PSD groups (OAKT group, ocular acupuncture group, and kinesitherapy group). Using fMRI scans and TMS-MEP approach, we will assess the central-peripheral neural function alterations in PSD as well as the coupling effects of OAKT on PSD. We plan to enroll 90 participants at the Hospital of Chengdu University of Traditional Chinese Medicine from Aug 31, 2022, to Dec 31, 2023, including 45 PSD and 45 HC subjects. After enrollment and on the last day after 4-weeks of waiting (HC subjects) or intervention (PSD subjects), all eligible subjects will be evaluated using fMRI scanning, TMS-MEP detection, and the MMT and Fugl-Mayer scales assessment. The MMT and Fugl-Meyer scores will be recorded, and a Pearson correlation analysis will be performed to assess the correlation between clinical and imaging outcomes.DiscussionFindings of this study will help to explain the central-peripheral coupling effect of OAKT on PSD and to further provide the neural processing of acupuncture kinesitherapy covering the entire pathway from peripheral to central nervous system.Clinical trial registrationThis study is registered with an identifier (ChiCTR2200060483) at the Chinese Clinical Trial Registry in June 2022. http://www.chictr.org.cn/index.aspx.

Design and In Vivo Testing of Novel Single-Stage Tendon Graft Using Polyurethane Nanocomposite Polymer for Tendon Reconstruction

Severe trauma, failure of prior surgical repair, delayed presentation and excessive scarring around the flexor tendon bed often necessitate a two-stage surgical reconstruction, where a silicone spacer is used in the first stage to recreate the fibro-osseous tunnel through which the tendon graft can glide in the second stage. This staged procedure involves great commitment on the part of both patient and surgeon, over the course of several months, involving a prolonged period of rehabilitation that can be quite disruptive to the patient's life and work. Reducing this from a two-stage into a single-stage procedure, therefore, has the potential to reduce rehabilitation time and cost, expedite return to work, and improve outcomes. To address this, we developed polyurethane (PU) nanocomposite, as an engineered tendon sheath, for treatment of delayed flexor tendon division as a single-stage procedure. The clinically conformant tubular grafts were tested for their efficacy in the peroneus tertius tendon of 6 Mule sheep for 3 months. Semi-quantitative histological assessment was carried out by analysing four descriptive layers: tendon, tendon/polymer sheath interface, polymer sheath, and polymer sheath/surrounding tissue. Four (out of 6) of the implanted PU nanocomposites showed moderate to substantial healing of the injured tendons, with minimal adhesion after repair, ensuring good gliding movement. No statistical differences were observed in tendon repair based on intra-regional variation in the explanted grafts, indicating homogeneity in tendon repair. Overall, the PU nanocomposite bears morphological stability and functionality for tendon repair, in single-stage surgical reconstruction, demonstrating promising evidence for clinical translation.

Use of intravenous lipid emulsion therapy as a novel treatment for brevetoxicosis in sea turtles

The southwest coast of Florida experiences annual red tides, a type of harmful algal bloom that results from high concentrations of Karenia brevis. These dinoflagellates release lipophilic neurotoxins, known as brevetoxins, that bind to sodium channels and inhibit their inactivation, resulting in a variety of symptoms that can lead to mass sea turtle strandings. Traditional therapies for brevetoxicosis include standard and supportive care (SSC) and/or dehydration therapy; however, these treatments are slow-acting and often ineffective. Because red tide events occur annually in Florida, our objective was to test intravenous lipid emulsion (ILE) as a rapid treatment for brevetoxicosis in sea turtles and examine potential impacts on toxin clearance rates, symptom reduction, rehabilitation time, and survival rates. Sea turtles exhibiting neurological symptoms related to brevetoxicosis were brought to rehabilitation from 2018–2019. Upon admission, blood samples were collected, followed by immediate administration of 25 mg ILE/kg body mass (Intralipid® 20%) at 1 mL/min using infusion pumps. Blood samples were collected at numerous intervals post-ILE delivery and analyzed for brevetoxins using enzyme-linked immunosorbent assays. In total, nine (four subadults, one adult female, four adult males) loggerheads (Caretta caretta), five (four juvenile, one adult female) Kemp’s ridleys (Lepidochelys kempii), and four juvenile green turtles (Chelonia mydas) were included in this study. We found that plasma brevetoxins declined faster compared to turtles that received only SSC. Additionally, survival rate of these patients was 94% (17/18), which is significantly higher than previous studies that used SSC and/or dehydration therapy (47%; 46/99). Nearly all symptoms were eliminated within 24–48 h, whereas using SSC, symptom elimination could take up to seven days or more. The dosage given here (25 mg/kg) was sufficient for turtles in this study, but the use of a higher dosage (50–100 mg/kg) for those animals experiencing severe symptoms may be considered. These types of fast-acting treatment plans are necessary for rehabilitation facilities that are already resource-limited. Intravenous lipid emulsion therapy has the potential to reduce rehabilitation time, save resources, and increase survival of sea turtles and other marine animals experiencing brevetoxicosis.

Dynamic Analysis of Lower Limb Exoskeleton Motion and Control Using Differential Transform Method

In this study, the nonlinear dynamic analysis of the motion and control of the lower limb exoskeleton using differential transform method is presented. Devices for medical processes are continuously undergoing improvement such as enhancing and assisting automatic therapies with flexible and configurable programs for treating people with partial disability in lower limbs as applied in lower-limb exoskeleton. The configurable programs in this exoskeleton can be applied to observe and control the motion of the exoskeleton for effective physiotherapy and reduced rehabilitation time for patients with such disability. Hence, a two degree of freedom nonlinear dynamic model for the motion and control of the lower limb exoskeletons was developed for two links. The nonlinear dynamic models are solved by applying the differential transform method (DTM) and verified with the forth order Runge-Kutta numerical method (RK4). The effects of the applied torque on the two links are investigated and it is observed that Link 1 has large negative deflection amplitude that drives link 2 towards the opposite positive direction. An increase in the applied torque resulted in increase in the amplitude of the system for all initial condition considered. This in turns increases the nonlinear dynamic behavior of link 2 due to its lower mass value. The speed of both links dampens out over the history due to the presence of damping term. At equilibrium, both links are in phase and have the same amplitude over the time history. This study provides an analytical tool for observing and controlling the motions of the lower limb exoskeleton and for improving the designs of the medical device.

ОГЛЯД МЕХАНІЧНИХ І ТЕРМОДИНАМІЧНИХ МОДЕЛЕЙ ШКІРИ ЛЮДИНИ В КОНТЕКСТІ ПЛАСТИЧНОЇ ХІРУРГІЇ

The purpose of the work is to review existing skin models based on its various properties: mechanical, thermodynamic, as well as skin growth models under the influence of external tension. The simplest model of structure of skin is an angiosomal theory. According to this model, a human body is divided by the separate three-dimensional areas, fed by the separate branches of arteries. There are three approaches to modeling the mechanical properties of the skin. The advantages and disadvantages of these models are noted. The question of the use of modeling in the field of plastic surgery, in particular, expander dermatension, is discussed. Mathematical modeling of skin growth is considered. It is noted that mechanical models of the skin are based on calculating the stress-strain relationship, and with a known dependence, if only the model fully reflects the real properties of the skin, it becomes possible to select such values and directions of deformations so that the stress is minimal. The considered models of skin functioning have the advantages of taking into account the real structure of the skin and the relative simplicity of the computational implementation. However, methods that implement such skin properties as non-linearity and anisotropy (along Langer lines and the location of the capillary network) are relatively poorly developed. At the same time, it is necessary to apply these approaches to modeling the process of skin stretching during an expander dermatension operation, taking into account real skin parameters. A promising approach is the use of thermal imaging diagnostics for imaging blood vessels in the process of balloon therapy. At the same time, observing the treated area in the infrared range will allow calculating the correspondence of the thermomechanical model to reality. Modeling the elastic properties of the skin will allow to take into account the functional features of expander dermatensia and the use of such models in plastic surgery will allow computer-aided planning of surgical interventions in the treatment of burns, reduce rehabilitation time and reduce the risk of complications.

Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: A retrospective analysis of 15 cases.

Background:Proximal tibia fractures with compartment syndrome present a challenge for orthopedic surgeons. More often than not these patients are subjected to multiple surgeries and are complicated by infection osteomyelitis and poor rehabilitation. There is no consensus in the management of these fractures. Most common mode is to do early fasciotomy with external fixation, followed by second stage definitive fixation. We performed a retrospective study of proximal tibia fractures with impending compartment syndrome treated by single stage fasciotomy and internal fixation. Results in terms of early fracture union, minimum complications and early patient mobilization were very good.Materials and Methods:Fifteen patients who were operated between July 2011 and June 2012 were selected for the study. All documents from their admission until the last followup in December 2013 were reviewed, data regarding complications collected and results were evaluated using Oxford Knee scoring system.Results:At the final outcome, there was anatomical or near anatomical alignment with no postoperative problems with range of motion of near complete flexion (>120) in all patients within 3 months. 13 patients started full weight bearing walking at 3 months. Delayed union in two patients and skin necrosis in one patient was observed.Conclusions:Since the results are encouraging and the rehabilitation time is much less when compared to conventional approaches, it is recommended using this protocol to perform early fasciotomy with the definitive internal fixation as single stage surgery to obtain excellent followup results and to reduce rehabilitation time, secondary trauma, expense of treatment and infection rate.

Analysis of arm elevation muscle activity through different movement planes and speeds during in-water and dry-land exercise

The objectives of this cross-sectional, analytical inference analysis were to compare shoulder muscle activation at arm elevations of 0° to 90° through different movement planes and speeds during in-water and dry-land exercise and to extrapolate this information to a clinical rehabilitation model. Six muscles of right-handed adult subjects (n = 16; males/females: 50%; age: 26.1 ± 4.5 years) were examined with surface electromyography during arm elevation in water and on dry land. Participants randomly performed 3 elevation movements (flexion, abduction, and scaption) through 0° to 90°. Three movement speeds were used for each movement as determined by a metronome (30°/sec, 45°/sec, and 90°/sec). Dry-land maximal voluntary contraction tests were used to determine movement normalization. Muscle activity levels were significantly lower in water compared with dry land at 30°/sec and 45°/sec but significantly higher at 90°/sec. This sequential progressive activation with increased movement speed was proportionally higher on transition from gravity-based on-land activity to water-based isokinetic resistance. The pectoralis major and latissimus dorsi muscles showed higher activity during abduction and scaption. These findings on muscle activation suggest protocols in which active flexion is introduced first at low speeds (30°/sec) in water, then at medium speeds (45°/sec) in water or on dry land, and finally at high speeds (90°/sec) on dry land before in water. Abduction requires higher stabilization, necessitating its introduction after flexion, with scaption introduced last. This model of progressive sequential movement ensures that early active motion and then stabilization are appropriately introduced. This should reduce rehabilitation time and improve therapeutic goals without compromising patient safety or introducing inappropriate muscle recruitment or movement speed.

Early Active Motion versus Immobilization after Tendon Transfer for Foot Drop Deformity: A Randomized Clinical Trial

BackgroundImmobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout.Questions/purposesTo confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems.MethodsWe randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16–38 months) in both groups.ResultsWe observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups.ConclusionIn patients with Hansen’s disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking.Level of Evidence Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Immediate Active Mobilization Versus Immobilization for Opposition Tendon Transfer in the Hand

To test the hypothesis that immediate postoperative active mobilization of the hand after opposition tendon transfer will achieve outcomes similar to those of the standard practice of cast immobilization. Five hands with isolated lower median nerve paralysis prospectively had opposition tendon transfer followed by immediate postoperative active mobilization for rehabilitation of the transfer. Historical records of 7 identical paralyses with opposition tendon transfers immobilized after surgery in a cast for 3 weeks were used for comparison. Outcomes were assessed by (1) the status of tendon transfer attachment to the thumb during immediate mobilization to detect tendon pullout, (2) the results of the opposition transfers for both groups using identical outcome measures (range of postoperative active abduction of the thumb, pinch pattern, pinch strength), and (3) comparison of the results from both groups. There were no incidences of tendon pullout during immediate active mobilization of opposition tendon transfer. There were no differences in outcome between the 2 groups at late follow-up evaluations, with all opposition transfers achieving good results. Immediate postoperative active mobilization reduced rehabilitation time by an average of 19 days. An earlier return to activities of daily living was a further benefit to patients. This study supports the hypothesis and suggests that similar outcomes can be achieved in reduced time by immediate active mobilization of opposition tendon transfer. Therapeutic, Level III.

Biographical work and returning to employment following a spinal cord injury

The question of returning to work after the onset of severe impairment is inseparable from the biographical work that disabled people need to achieve. Qualitative analysis of interviews I carried out among people who had become paraplegic and among rehabilitation professionals offered the following insights: * During a period extending beyond rehabilitation, interviewees were absorbed by the work of coming to terms with their impairment and delegated the question of occupation to the professionals. At a later date, some of them manage to recast their biographies and gain ownership of their occupations and activities for themselves. An open environment, which offers negotiable opportunities and space for relationships to form, encourages the development of biographical work. Nowadays, the question of exclusion would appear to dominate the domain of rehabilitation. The belief that prolonged inactivity engenders marginalisation has led professionals to develop a doctrine whereby they encourage their patients to plan for their professional activities from a very early stage. Struggling with different time demands (for example, lengthy administrative procedures and reduced rehabilitation time) professionals organise their work around a new time frame which conflicts with their expertise and is difficult to reconcile with the trajectories of disabled people.

The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively—a randomised clinical trial

Aim: Recent evidence suggests that the provision of energy-containing fluids is safe and may impact positively on markers of recovery. The aims of this study were to assess the tolerance of preoperative carbohydrate fluid administration and to determine its effect on postoperative metabolic and clinical responses.Methods: Patients admitted to the Royal Infirmary of Edinburgh for major, elective abdominal surgery were recruited to this double-blind, randomised study and received either a placebo drink or carbohydrate (12.6g/100ml) drink (CHOD). Patients consumed 800ml of their drink on the evening before surgery and 400ml on the day of surgery 2–3h before the induction of anaesthesia. Nutritional status was determined using body mass index (BMI) and upper arm anthropometry; all measurements were taken preoperatively, postoperatively and at discharge. Blood glucose and insulin concentrations were also measured preoperatively and on the first post operative day. Length of hospital stay (LOS) and postoperative complications were recorded.Results: Seventy-two patients were recruited and 65 (34 male:31 female) completed this study. Thirty-four patients were randomised to receive the placebo drink (control group) and 31 patients to receive the carbohydrate drink (CHOD group). Groups were well-matched in terms of gender and age. There were no differences between the two groups at baseline for BMI (control: −25.1±1.7kg/m2; CHOD −25.2±1.2kg/m2), upper arm anthropometry or surgical procedure. At discharge loss of muscle mass (arm muscle circumference) was significantly greater in the control group when compared with the CHOD group (control: −1.1±0.15cm; CHOD: −0.5±0.16cm; P<0.05). Baseline insulin (control: 20.7±4.9mU/l; CHOD: 24.6±6.2mU/l) and glucose (control: 6.0±1.4mmol/l; CHOD 5.7±1.4mmol/l) were comparable in the two groups and did not differ postoperatively. No complications were recorded as a result of preoperative fluid consumption. Postoperative morbidity occurred in six patients from each group. Median LOS in the control group was 10 days (IQR=6), and 8 days (IQR=4) in the CHOD group.Conclusion: Preoperative consumption of carbohydrate-containing fluids is safe. Provision of a carbohydrate energy source prior to surgery may attenuate depletion of muscle mass after surgery. Further studies are required to determine if this preservation of muscle mass is reflected in improved function and reduced rehabilitation time.

Evaluation of two direct immunoassays for rapid detection of petroleum products on marine birds

To reduce rehabilitation time and improve survival, a practical, objective test is needed to determine if marine birds are contaminated with oil before they enter captivity. The RaPID Assay ® and EnviroGard TM immunoassays for detection of polycyclic aromatic hydrocarbons (PAHs) in soil were evaluated for their ability to detect petroleum on feather samples from 30 intermediate fuel oil contaminated and 30 uncontaminated common murres ( Uria aalge). Sensitivity, specificity, positive and negative predictive value, precision, and time required to run each assay were determined. The RaPID Assay ® was 96.7% sensitive and specific, while the EnviroGard TM assay was 93.3% sensitive, and 90.0% specific. Sensitivity decreased at higher dilutions for both assays. Intra-replicate variation was less than 20%. Our evaluation showed that these immunoassays are rapid and cost-effective methods for detecting oil-contamination on the plumage of seabirds, with the EnviroGard TM assay being more practical in most oil spill response situations due to ease of use and rapidity of results.