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The Journal of Hand Surgery Mar 2023The purpose of this study was to determine if the use of postoperative therapeutic dose intravenous heparin (POTDIVH) was indicated in digital replantation and...
PURPOSE
The purpose of this study was to determine if the use of postoperative therapeutic dose intravenous heparin (POTDIVH) was indicated in digital replantation and revascularization by assessing digit survival and complications associated with heparin.
METHODS
All patients with amputation distal to the carpal tunnel treated at our center from 2004 to 2020 were included for chart review. Digit survival and complication rates were compared between patients who received POTDIVH (group A) and those who did not (group B). Logistic regression analysis and subgroup analysis were conducted.
RESULTS
A total of 795 patients (1,155 digits) were included in this study (248 patients/374 digits in group A and 547 patients/781 digits in group B). The overall revascularization and replantation success rate was 79.9% in the POTDIVH group and 92.8% in the non-POTDIVH group. In our retrospective regression and subgroup analyses, group A demonstrated increased odds of failure compared with group B and was associated with increased bleeding-related complications. Subgroup analyses stratified by the mechanism of injury and vein grafting also showed a significantly decreased survival in the POTDIVH group.
CONCLUSIONS
Our retrospective data seem to indicate that heparin in digit replantation and revascularization appears to have no benefit on digit survival across all subgroups, including crush and avulsion injuries, and is associated with a significantly increased rate of complications.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Humans; Retrospective Studies; Amputation, Traumatic; Finger Injuries; Heparin; Replantation; Fingers
PubMed: 36266149
DOI: 10.1016/j.jhsa.2022.08.011 -
Frontiers in Neuroscience 2023The aim of the present study is to evaluate the effect of vibrotactile stimulation prior to repeated complex motor imagery of finger movements using the non-dominant...
PURPOSE
The aim of the present study is to evaluate the effect of vibrotactile stimulation prior to repeated complex motor imagery of finger movements using the non-dominant hand on motor imagery (MI) performance.
METHODS
Ten healthy right-handed adults (4 females and 6 males) participated in the study. The subjects performed motor imagery tasks with and without a brief vibrotactile sensory stimulation prior to performing motor imagery using either their left-hand index, middle, or thumb digits. Mu- and beta-band event-related desynchronization (ERD) at the sensorimotor cortex and an artificial neural network-based digit classification was evaluated.
RESULTS
The ERD and digit discrimination results from our study showed that ERD was significantly different between the vibration conditions for the index, middle, and thumb. It was also found that digit classification accuracy with-vibration (mean ± SD = 66.31 ± 3.79%) was significantly higher than without-vibration (mean ± SD = 62.68 ± 6.58%).
CONCLUSION
The results showed that a brief vibration was more effective at improving MI-based brain-computer interface classification of digits within a single limb through increased ERD compared to performing MI without vibrotactile stimulation.
PubMed: 37360173
DOI: 10.3389/fnins.2023.1152563 -
JPRAS Open Jun 2022Polydactyly is characterized by the manifestation of supernumerary digits in the hands and feet. It can be isolated or associated with a genetic syndrome. Based on the...
Polydactyly is characterized by the manifestation of supernumerary digits in the hands and feet. It can be isolated or associated with a genetic syndrome. Based on the location of duplication, it is categorized as preaxial, postaxial, or central. The latter is a rare abnormality, comprising approximately 6% of cases. There is a paucity in the literature regarding this congenital anomaly and its overall management. Nonoperative treatment is generally unsuccessful in managing symptoms such as excessive width, abnormal digit alignment, and growth. Though surgical management addresses the individual patient's needs, general goals include preservation of digits with the greatest axial alignment, resection of symptomatic digits, alignment correction of the remaining great toe, stabilization of the soft tissues, and adequate soft tissue coverage. This study aims to delineate effective operative techniques for central foot polydactyly. Two patient cases are discussed, providing a framework for pre and postoperative care, complications, and outcomes. The techniques detailed offer a straightforward, efficacious, and safe method to reconstruct central foot polydactyly, returning form and function to the patient.
PubMed: 35330745
DOI: 10.1016/j.jpra.2022.01.006 -
Ear and HearingListening effort is needed to understand speech that is degraded by hearing loss, a noisy environment, or both. This in turn reduces cognitive spare capacity, the amount...
OBJECTIVES
Listening effort is needed to understand speech that is degraded by hearing loss, a noisy environment, or both. This in turn reduces cognitive spare capacity, the amount of cognitive resources available for allocation to concurrent tasks. Predictive sentence context enables older listeners to perceive speech more accurately, but how does contextual information affect older adults' listening effort? The current study examines the impacts of sentence context and cognitive (memory) load on sequential dual-task behavioral performance in older adults. To assess whether effects of context and memory load differ as a function of older listeners' hearing status, baseline working memory capacity, or both, effects were compared across separate groups of participants with and without hearing loss and with high and low working memory capacity.
DESIGN
Participants were older adults (age 60-84 years; n = 63) who passed a screen for cognitive impairment. A median split classified participants into groups with high and low working memory capacity. On each trial, participants listened to spoken sentences in noise and reported sentence-final words that were either predictable or unpredictable based on sentence context, and also recalled short (low-load) or long (high-load) sequences of digits that were presented visually before each spoken sentence. Speech intelligibility was quantified as word identification accuracy, and measures of listening effort included digit recall accuracy, and response time to words and digits. Correlations of context benefit in each dependent measure with working memory and vocabulary were also examined.
RESULTS
Across all participant groups, accuracy and response time for both word identification and digit recall were facilitated by predictive context, indicating that in addition to an improvement in intelligibility, listening effort was also reduced when sentence-final words were predictable. Effects of predictability on all listening effort measures were observed whether or not trials with an incorrect word identification response were excluded, indicating that the effects of predictability on listening effort did not depend on speech intelligibility. In addition, although cognitive load did not affect word identification accuracy, response time for word identification and digit recall, as well as accuracy for digit recall, were impaired under the high-load condition, indicating that cognitive load reduced the amount of cognitive resources available for speech processing. Context benefit in speech intelligibility was positively correlated with vocabulary. However, context benefit was not related to working memory capacity.
CONCLUSIONS
Predictive sentence context reduces listening effort in cognitively healthy older adults resulting in greater cognitive spare capacity available for other mental tasks, irrespective of the presence or absence of hearing loss and baseline working memory capacity.
Topics: Aged; Aged, 80 and over; Deafness; Hearing Loss; Humans; Listening Effort; Memory, Short-Term; Middle Aged; Speech Intelligibility; Speech Perception
PubMed: 34983897
DOI: 10.1097/AUD.0000000000001192 -
Annals of Plastic Surgery Jun 2024A common consideration for replantation success is the ischemia time following injury and the preservation temperature. A classic principle within the hand surgery... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
A common consideration for replantation success is the ischemia time following injury and the preservation temperature. A classic principle within the hand surgery community describes 12 hours of warm ischemia and 24 hours of cold ischemia as the upper limits for digit replantation; however, these limits are largely anecdotal and based on older studies. We aimed to compare survival data from the large body of literature to aid surgeons and all those involved in the replantation process in hopes of optimizing success rates.
METHODS
The PubMed database was queried on April 4th, 2023, for articles that included data on digit replantation survival in terms of temperature of preservation and ischemia time. All primary outcomes were analyzed with the Mantel-Haenszel method within a random effects model. Secondary outcomes were pooled and analyzed using the chi-square statistic. Statistical analysis and forest plot generation were completed with RevMan 5.4 software with odds ratios calculated within a 95% confidence interval.
RESULTS
Our meta-analysis identified that digits preserved in cold ischemia for over 12 hours had significantly higher odds of replantation success than the amputated digits replanted with 0-12 hours of warm ischemia time ( P ≤ 0.05). The odds of survival in the early (0-6 hours) replantation group were around 40% greater than the later (6-12 hours) replantation group ( P ≤ 0.05). Secondary outcomes that were associated with higher survival rates included a clean-cut amputation, increased venous and arterial anastomosis, a repair that did not require a vein graft, and replants performed in nonsmokers ( P ≤ 0.05).
DISCUSSION
Overall, these findings suggest that when predicting digit replantation success, time is of the essence when the digit has yet to be preserved in a cold environment. This benefit, however, is almost completely diminished when the amputated digit is appropriately maintained in a cold environment soon after injury. In conclusion, our results suggest that there is potential for broadening the ischemia time limits for digit replant survival outlined in the literature, particularly for digits that have been stored correctly in cold ischemia.
Topics: Humans; Replantation; Amputation, Traumatic; Finger Injuries; Time Factors; Fingers; Warm Ischemia; Cold Ischemia; Ischemia; Temperature
PubMed: 38725110
DOI: 10.1097/SAP.0000000000003944 -
Cognition & Emotion Mar 2021Previous research on the spatial-numerical association of response codes (SNARC) has demonstrated that SNARC-compatible digit arrangements are processed faster and more...
Previous research on the spatial-numerical association of response codes (SNARC) has demonstrated that SNARC-compatible digit arrangements are processed faster and more accurately than SNARC-incompatible arrangements. Concurrently, processing speed and accuracy have been conceptualised as indicating processing fluency - the ease of information processing - which has been shown to entail affective downstream consequences. Bridging these two research lines for the first time, we investigated whether digit arrangements that are compatible to this association are affectively preferred to association-incompatible digit arrangements. In a line of four experiments (total = 786), German participants were asked to indicate how much they like the overall appearance of two digits that appear at the right and at the left side of the screen. Results from three of the four experiments suggest that digit arrangements that are compatible with this spatial-numerical association indeed trigger positive feelings. These preference patterns were not moderated by the horizontal distance between the two digits, pointing towards a stable phenomenon that is insensitive to contextual spatial cues.
Topics: Cognition; Cues; Emotions; Humans; Reaction Time; Space Perception
PubMed: 33174803
DOI: 10.1080/02699931.2020.1846018 -
Journal of Experimental Psychology.... Mar 2022Little is known about the mental representation of large multidigit numbers that are usually beyond our personal experience. The present study explored the processing...
Little is known about the mental representation of large multidigit numbers that are usually beyond our personal experience. The present study explored the processing mechanisms of these numbers in a series of experiments, using the numerical comparison task. Experiment 1 included within and between-scale comparisons of multidigit numbers varying in their left digits (e.g., 8,000,000), with one group comparing small numbers (tens, hundreds, and thousands) and the other large ones (millions, billions, and trillions). In Experiment 2, comparisons of small (tens, hundreds) and large (millions, billions) multidigit numbers that varied in their left and right digits (e.g., 8,000,003) were presented in separate blocks. Experiment 3 presented small and large multidigit numbers (from tens to trillions) that varied in their left digits in the same block. We found novel compatibility effects between the left digit and scale components, as well as between the left digit, right digit, and scale components, and extended the previously reported unit-decade compatibility effect to larger scales. We also obtained global and scale distance effects for all scales in most conditions. Both compatibility and distance effects showed context dependency in large, but not small, multidigit numbers. Overall, these results demonstrate that small and large multidigit numbers are processed differently. We discuss these differences and propose a processing model that accounts for them. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PubMed: 35389727
DOI: 10.1037/xlm0001126 -
Cortex; a Journal Devoted To the Study... Feb 2024The processing of numerals as visual objects is supported by an "Inferior Temporal Numeral Area" (ITNA) in the bilateral inferior temporal gyri (ITG). Extant findings...
The processing of numerals as visual objects is supported by an "Inferior Temporal Numeral Area" (ITNA) in the bilateral inferior temporal gyri (ITG). Extant findings suggest some degree of hemispheric asymmetry in how the bilateral ITNAs process numerals. Pollack and Price (2019) reported such a hemispheric asymmetry by which a region in the left ITG was sensitive to digits during a visual search for a digit among letters, and a homologous region in the right ITG that showed greater digit sensitivity in individuals with higher calculation skills. However, the ITG regions were localized with separate analyses without directly contrasting their digit sensitivities and relation to calculation skills. So, the extent of and reasons for these functional asymmetries remain unclear. Here we probe whether the functional and representational properties of the ITNAs are asymmetric by applying both univariate and multivariate region-of-interest analyses to Pollack and Price's (2019) data. Contrary to the implications of the original findings, digit sensitivity did not differ between ITNAs, and digit sensitivity in both left and right ITNAs was associated with calculation skills. Representational similarity analyses revealed that the overall representational geometries of digits in the ITNAs were also correlated, albeit weakly, but the representational contents of the ITNAs were largely inconclusive. Nonetheless, we found a right lateralization in engagement in alphanumeric categorization, and that the right ITNA showed greater discriminability between digits and letters. Greater right lateralization of digit sensitivity and digit discriminability in the left ITNA were also related to higher calculation skills. Our findings thus suggest that the ITNAs may not be functionally identical and should be directly contrasted in future work. Our study also highlights the importance of within-individual comparisons for understanding hemispheric asymmetries, and analyses of individual differences and multivariate features to uncover effects that would otherwise be obscured by averages.
Topics: Humans; Magnetic Resonance Imaging; Functional Laterality; Temporal Lobe; Multivariate Analysis; Individuality; Brain Mapping
PubMed: 37992508
DOI: 10.1016/j.cortex.2023.08.018 -
Journal of Plastic, Reconstructive &... Sep 2023The replantation of multiple amputated digits is a technically challenging procedure for reconstructive surgeons that requires more time than the replantation of a...
PURPOSE
The replantation of multiple amputated digits is a technically challenging procedure for reconstructive surgeons that requires more time than the replantation of a single digit. We evaluated the effect of multiple-digit replantation on the success of digital replantation.
METHODS
Patients who experienced digital amputation and underwent digital replantation from January 2018 to December 2021 were studied retrospectively. Patients who experienced successful and failed replantation were compared, as were digits that survived or became necrotic after replantation. A multivariate logistic regression (MLR) analysis was performed to evaluate the independent factors of replanted digit survival.
RESULTS
There were 378 patients with 497 amputated digits who underwent digital replantation. Of all 378 patients, 298 underwent single-digit replantation, and the other 80 patients underwent multiple-digit replantation. A total of 83.3% of the replanted digits survived (414 of 497). Compared with patients with surviving replanted digits, significantly more patients with necrotic replanted digits underwent multiple-digit replantation (37.7% vs. 17.5%, p < 0.001). On the other hand, a digit that developed necrosis after replantation was more likely to have been involved in the replantation of three or more digits (16% vs. 29%, p = 0.005). The subsequent MLR analysis revealed that the likelihood of necrosis was 2.355 (p = 0.003) times higher in the replantation of three or more digits than in the replantation of one or two digits.
CONCLUSION
Patients who underwent multiple-digit replantation exhibited a higher incidence of necrosis in the replanted digits. In cases involving patients with multiple-digit amputation, it is crucial to prioritize and perform selective replantation based on the amputated digits.
Topics: Humans; Amputation, Traumatic; Finger Injuries; Retrospective Studies; Replantation; Fingers; Amputation, Surgical; Necrosis
PubMed: 37467694
DOI: 10.1016/j.bjps.2023.06.026 -
Attention, Perception & Psychophysics Apr 2021There is a growing body of research on ensemble perception, or our ability to form ensemble representations based on perceptual features for stimuli of varying levels of...
There is a growing body of research on ensemble perception, or our ability to form ensemble representations based on perceptual features for stimuli of varying levels of complexity, and more recently, on ensemble cognition, which refers to our ability to perceive higher-level properties of stimuli such as facial attractiveness or gaze direction. Less is known about our ability to form ensemble representations based on more abstract properties such as the semantic meaning associated with items in a scene. Previous work examining whether the meaning associated with digits can be incorporated into summary statistical representations suggests that numerical information from digit ensembles can be extracted rapidly, and likely using a parallel processing mechanism. Here, we further investigate whether participants can accurately generate summary representations of numerical value from digit sets and explore the effect of set size on their ability to do so, by comparing psychometric functions based on a numerical averaging task in which set size varied. Steeper slopes for ten- and seven-item compared to five-item digit sets provide evidence that displays with more digits yield more reliable discrimination between larger and smaller numerical averages. Additionally, consistent with previous reports, we observed a response bias such that participants were more likely to report that the numerical average was "greater than 5" for larger compared to smaller sets. Overall, our results contribute to evidence that ensemble representations for semantic attributes may be carried out via similar mechanisms as those reported for perceptual features.
Topics: Cognition; Face; Humans; Perception; Psychometrics; Semantics; Size Perception
PubMed: 33389674
DOI: 10.3758/s13414-020-02196-8