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Journal of Endovascular Therapy : An... Dec 2023To identify potential hemodynamic predictors for limb thrombosis (LT) following endovascular aneurysm repair with the Anaconda endograft in a patient-specific phantom.
PURPOSE
To identify potential hemodynamic predictors for limb thrombosis (LT) following endovascular aneurysm repair with the Anaconda endograft in a patient-specific phantom.
MATERIALS AND METHODS
A thin-walled flow phantom, based on a patient's aortic anatomy and treated with an Anaconda endograft, that presented with a left-sided LT was fabricated. Contrast-enhanced ultrasound particle image velocimetry was performed to quantify time-resolved velocity fields. Measurements were performed in the same phantom with and without the Anaconda endograft, to investigate the impact of the endograft on the local flow fields. Hemodynamic parameters, namely vector complexity (VC) and residence time (RT), were calculated for both iliac arteries.
RESULTS
In both limbs, the vector fields were mostly unidirectional during the peak systolic and end-systolic velocity phases before and after endograft placement. Local vortical structures and complex flow fields were observed at the diastolic and transitional flow phases. The average VC was higher (0.11) in the phantom with endograft, compared to the phantom without endograft (0.05). Notably, in both left and right iliac arteries, the anterior wall regions corresponded to a 2- and 4-fold increase in VC in the phantom with endograft, respectively. RT simulations showed values of 1.3 to 6 seconds in the phantom without endograft. A higher RT (up to 25 seconds) was observed in the phantom with endograft, in which the left iliac artery, with LT in follow-up, showed 2 fluid stasis regions.
CONCLUSION
This in vitro study shows that unfavorable hemodynamics were present mostly in the limb that thrombosed during follow-up, with the highest VC and longest RT. These parameters might be valuable in predicting the occurrence of LT in the future.
CLINICAL IMPACT
This in-vitro study aimed to identify potential hemodynamic predictors for limb thrombosis following EVAR using ultrasound particle image velocimetry (echoPIV) technique. It was shown that unfavorable hemodynamic norms were present mostly in the thrombosed limb. Owing to the in-vivo feasibility of the echoPIV, future efforts should focus on the evaluation of these hemodynamic norms in clinical trials. Thereafter, using echoPIV as a bedside technique in hospitals becomes more promising. Performing echoPIV in pre-op phase may provide valuable insights for surgeons to enhance treatment planning. EchoPIV is also applicable for follow-up sessions to evaluate treatment progress and avoid/predict complications.
PubMed: 38149463
DOI: 10.1177/15266028231219988 -
Pain Apr 2024Combat trauma can lead to widespread tissue damage and limb loss. This may result in chronic neuropathic and post amputation pain, including phantom limb pain (PLP) and... (Meta-Analysis)
Meta-Analysis
Combat trauma can lead to widespread tissue damage and limb loss. This may result in chronic neuropathic and post amputation pain, including phantom limb pain (PLP) and residual limb pain (RLP). The military population is distinct with respect to demographic, injury, and social characteristics compared with other amputation and trauma cohorts. We undertook a systematic review of studies of military personnel, with a history of combat injury, that reported a prevalence of any type of postamputation pain or chronic neuropathic pain, identified from Embase and MEDLINE databases.Using the inverse variance method with a random-effects model, we undertook a meta-analysis to determine an overall prevalence and performed exploratory analyses to identify the effect of the type of pain, conflict, and time since injury on prevalence. Pain definitions and types of pain measurement tools used in studies were recorded. Thirty-one studies (14,738 participants) were included. The pooled prevalence of PLP, RLP, and chronic neuropathic pain were 57% (95% CI: 46-68), 61% (95% CI: 50-71), and 26% (95% CI: 10-54), respectively. Between-study heterogeneity was high (I 2 : 94%-98%). Characterisation of duration, frequency, and impact of pain was limited. Factors reported by included studies as being associated with PLP included the presence of RLP and psychological comorbidity. The prevalence of postamputation pain and chronic neuropathic pain after combat trauma is high. We highlight inconsistency of case definitions and terminology for pain and the need for consensus in future research of traumatic injury.
Topics: Humans; Military Personnel; Prevalence; Pain Measurement; Neuralgia; Phantom Limb
PubMed: 38112578
DOI: 10.1097/j.pain.0000000000003094 -
Frontiers in Human Neuroscience 2023Several reports have demonstrated the effectiveness of neurorehabilitation, such as mirror therapy or virtual reality, in treating phantom limb pain (PLP). This case...
Several reports have demonstrated the effectiveness of neurorehabilitation, such as mirror therapy or virtual reality, in treating phantom limb pain (PLP). This case study describes the effect of virtual reality training (VRT) on severe, long-term PLP and upper limb activity on the amputated side in a patient who underwent digit amputation 9 years prior. A woman in her 40 s underwent amputation of 2-5 fingers 9 years prior due to a workplace accident. She experienced persistent pain in the palms of her hand near the amputation sites. A single case design (ABA'B') was applied. Periods A and A' were set as periods without VRT intervention, and Periods B and B' were set as periods with VRT intervention. Periods A, B, A', and B' lasted 4, 10, 8, and 10 weeks, respectively. VRT was a task during which visual stimulation and upper limb movements were linked. The task consisted of catching a rolling ball in the display with a virtual hand, operated with both hands using a controller. VRT was performed once every 2-4 weeks for 30 min. Pain intensity was assessed using the short-form McGill Pain Questionnaire-2. Bilateral upper limb activity was measured continuously for 24 h using a triaxial accelerometer attached to the right and left wrist joints. The pain intensity was 147/220 points during Period A, 128 points during Period B, 93 points during Period A', and 100 points during Period B', showing a gradual decrease. Upper limb activity occurred mainly on the intact side during Periods A and B, whereas the activity on the amputated side increased 2-fold after Period A', and both upper extremities were used equally. Virtual reality training resulted in reduced pain intensity and increased activity in the upper limb. VRT may have induced reintegration of the sensory-motor loop, leading to a decrease in the PLP intensity. The upper limb activity on the amputated side may have also increased with the pain reduction. These results suggest that VRT may be valuable in reducing severe, long-term PLP.
PubMed: 38107594
DOI: 10.3389/fnhum.2023.1246865 -
Basic and Clinical Neuroscience 2023Phantom limb pain (PLP) as neuropathic pain affects the life of amputees. It is believed an efficient PLP treatment should consider the underlying neurological...
INTRODUCTION
Phantom limb pain (PLP) as neuropathic pain affects the life of amputees. It is believed an efficient PLP treatment should consider the underlying neurological mechanisms. Hereby, we investigated brain activity in PLP and its relationships to the psychological and cognitive dimensions of chronic pain. We investigate differences in resting brain activities between amputees with and without pain. We hypothesize significant differences in the motor cortex and parietal cortex activity that are related to pain perception. Also, we hypothesize two groups have significant differences in cognitive and psychological components.
METHODS
Behavioral assessment (psychological status, life satisfaction, and pain level) and EEG signals of 19 amputees (12 without pain and 7 with pain) were recorded. Data were statistically compared between the two groups. Also, the association between behavioral and neurophysiological data was computed.
RESULTS
The results showed a significant decrease in the pain group for the beta and gamma waves, as well as, for the theta and delta waves in the posterior temporal on both sides, during the eye-open condition. The eyes-closed condition showed that the delta waves were decreased on the right side of the cortex. Also, data showed a significant difference in the correlation of pain features with brain waves between the two groups.
CONCLUSION
Significant differences were mostly observed in regions related to pain perception rather than the motor cortex. This can be due to the learned strategies to deal with pain and the degree of pain. Results showed maladaptive cognitive processes had a relationship with brain wave activities. According to the result of brain wave activities, it seems that cognitive factors have a role in the experience of PLP rather than neuroplasticity through amputation.
HIGHLIGHTS
Differences found in the parietal and temporal regions of phantom limb pain's (PLP's) suggests cognition's role in the persistence of PLP.Decreased delta power at the posterior temporal cortex in PLP's could be the focus of treatments.Increased activity of the parietal cortex could be helpful in the treatment of PLP's.
PLAIN LANGUAGE SUMMARY
PLP is an annoying neurologic pain. A wide range of treatments have focused on this type of pain but couldn't be effective. Recently, researchers suggest BCI-based treatments for better treatment. For this type of treatment, we should know the neurological aspect of PLP. In most studies to investigate or treatment of neurological aspects of PLP, researchers induced pain experimentally or studied acute phantom limb pain. We believed for a better understanding of PLP, should investigate it in a natural and stabilized position. Therefore we studied brain activities in amputees with and without PLP in a resting state to find out differences. Trends in this field express the alpha band differences in the motor cortex. On the contrary, our results showed the most significant difference in high-frequency bandpasses such as beta and gamma. Also, in our study, it seems the parietal and temporal cortex that are related to pain perception is the more relevant to PLP. This study showed a psycho-cognitive aspect of pain such as pain exaggeration has a relation with PLP's brain wave activities. So, we can suggest rather than neuroplasticity through amputation, cognitive factors have a role in the experience of PLP.
PubMed: 38107525
DOI: 10.32598/bcn.2021.261.1 -
Journal of Pain Research 2023Postamputation neuropathic pain is a common disease in patients with malignant tumor amputation, seriously affecting amputees' quality of life and mental health. The...
PURPOSE
Postamputation neuropathic pain is a common disease in patients with malignant tumor amputation, seriously affecting amputees' quality of life and mental health. The objective of this study was to identify independent risk factors for phantom limb pain in patients with tumor amputation and to construct a risk prediction model.
METHODS
Patients who underwent amputation due to malignant tumors from 2013 to 2023 were retrospectively analyzed and divided into phantom limb pain group and non-phantom limb pain group. To determine which preoperative factors would affect the occurrence of phantom limb pain, we searched for candidate factors by univariate analysis and used multivariate logistic regression analysis to identify independent factors and construct a predictive model. The receiver operating characteristic curve (ROC) was drawn to further evaluate the accuracy of the prediction model in evaluating the phantom limb pain after amputation of bone and soft tissue tumors.
RESULTS
Multivariate analysis showed that age (OR, 1.054; 95% CI, 1.027 to 1.080), preoperative pain (OR, 5.773; 95% CI, 2.362 to 14.104), number of surgeries (OR, 3.425; 95% CI, 1.505 to 7.795), amputation site (OR, 5.848; 95% CI, 1.837 to 18.620), amputation level (OR, 8.031; 95% CI, 2.491 to 25.888) were independent risk factors for phantom limb pain for bone and soft tissue tumors. The the area under the curve (AUC) of this model was 0.834.
CONCLUSION
Risk factors for postoperative phantom limb pain were the site of amputation, proximal amputation, preoperative pain, multiple amputations, and older age. These factors will help surgeons to individualize and stratify phantom limb pain and help patients with risk counseling. In particular, an informed clinical decision targeting those modifiable factors can be considered when needed.
PubMed: 38026454
DOI: 10.2147/JPR.S433996 -
Plastic and Reconstructive Surgery.... Nov 2023Neurofibromatosis type 1 (NF1) is an inherited multisystem disorder that affects one in 2500 to one in 5000 people. Neurofibromas are the second-most common benign...
Neurofibromatosis type 1 (NF1) is an inherited multisystem disorder that affects one in 2500 to one in 5000 people. Neurofibromas are the second-most common benign peripheral nerve sheath tumors arising from Schwann cells and are associated with neurofibromatosis. Chronic pain and opioid use is elevated in patients with NF1 when neurofibromas are associated with sensory nerves. Surgical excision is the primary treatment of neurofibromas when they become large, malignant, or painful, but they are associated with high rates of recurrence. Targeted muscle reinnervation and regenerative peripheral nerve interfaces are two prophylactic surgical techniques that are used to prevent neuroma-associated residual limb and phantom pain in amputees. Both techniques stimulate physiologic regeneration of the nerve via trophic stimulus from denervated muscle. This case report describes two patients with NF1 who underwent targeted muscle reinnervation and/or regenerative peripheral nerve interfaces at the time of amputation. Despite the abnormality of the peripheral nerves involved, both patients had excellent postoperative outcomes with minimal pain. This experience advocates for the use of prophylactic nerve management techniques in neurofibromatosis patients despite baseline nerve pathology.
PubMed: 38025622
DOI: 10.1097/GOX.0000000000005405 -
IEEE Transactions on Neural Systems and... 2023There has been increased interest in using residual muscle activity for neural control of powered lower-limb prostheses. However, only surface electromyography...
There has been increased interest in using residual muscle activity for neural control of powered lower-limb prostheses. However, only surface electromyography (EMG)-based decoders have been investigated. This study aims to investigate the potential of using motor unit (MU)-based decoding methods as an alternative to EMG-based intent recognition for ankle torque estimation. Eight people without amputation (NON) and seven people with amputation (AMP) participated in the experiments. Subjects conducted isometric dorsi- and plantarflexion with their intact limb by tracing desired muscle activity of the tibialis anterior (TA) and gastrocnemius (GA) while ankle torque was recorded. To match phantom limb and intact limb activity, AMP mirrored muscle activation with their residual TA and GA. We compared neuromuscular decoders (linear regression) for ankle joint torque estimation based on 1) EMG amplitude (aEMG), 2) MU firing frequencies representing neural drive (ND), and 3) MU firings convolved with modeled twitch forces (MUDrive). In addition, sensitivity analysis and dimensionality reduction of optimization were performed on the MUDrive method to further improve its practical value. Our results suggest MUDrive significantly outperforms (lower root-mean-square error) EMG and ND methods in muscles of NON, as well as both intact and residual muscles of AMP. Reducing the number of optimized MUDrive parameters degraded performance. Even so, optimization computational time was reduced and MUDrive still outperformed aEMG. Our outcomes indicate integrating MU discharges with modeled biomechanical outputs may provide a more accurate torque control signal than direct EMG control of assistive, lower-limb devices, such as exoskeletons and powered prostheses.
Topics: Humans; Ankle; Ankle Joint; Torque; Lower Extremity; Muscle, Skeletal; Electromyography; Amputation, Surgical
PubMed: 38015668
DOI: 10.1109/TNSRE.2023.3336543 -
Explore (New York, N.Y.) 2024Phantom limb pain (PLP) is a distressing consequence commonly encountered by individuals who have undergone amputations. The efficacy of treatment options for PLP is...
Phantom limb pain (PLP) is a distressing consequence commonly encountered by individuals who have undergone amputations. The efficacy of treatment options for PLP is limited. In this study, we present a case of a 64-year-old male who suffered from PLP for a duration of 10 years following an above-the-knee amputation. Despite unsuccessful attempts with painkillers and neurotrophic drugs over the course of a decade, the patient sought relief through Fu's Subcutaneous Needling (FSN), an innovative acupuncture therapy that specifically targets the subcutaneous tissue for pain management. Remarkably, the patient experienced a significant reduction in PLP and subsequently decreased his reliance on medication, as well as experiencing improved sleep after undergoing one session of FSN per day for four consecutive days. A follow-up conducted three years later demonstrated positive treatment outcomes. FSN demonstrated a significant influence on PLP, resulting in reduced analgesic requirements and enhanced quality of life. Therefore, FSN may be recommended as an additional treatment option for PLP. In order to gain a comprehensive understanding of the effects of acupuncture on PLP, a systematic review of relevant literature was conducted in PubMed, Embase, Cochrane Library and Web of Science in recent 20 years (from January 1, 2003 to October 16, 2023), using different combinations of the following terms: (phantom acrodynia), (residual limb pain), (phantom limb pain), (acupuncture), (electroacupuncture), (auriculoacupuncture), and (needling). 9 articles with 18 cases including one randomized controlled trial (n = 8) were obtained. This review provided additional evidence supporting the efficacy and safety of needling therapies for PLP. This systematic review offers additional evidence supporting the effectiveness and safety of needling therapies for PLP. However, there were no precedent reports using FSN treatment for PLP. Hence, this case may provide some implications for clinicians in practice.
Topics: Humans; Male; Phantom Limb; Middle Aged; Acupuncture Therapy; Pain Management; Quality of Life; Amputation, Surgical; Treatment Outcome
PubMed: 38008590
DOI: 10.1016/j.explore.2023.11.011 -
JMIR Serious Games Nov 2023Virtual reality (VR) is a computer simulation technique that has been increasingly applied in pain management over the past 2 decades.
BACKGROUND
Virtual reality (VR) is a computer simulation technique that has been increasingly applied in pain management over the past 2 decades.
OBJECTIVE
In this study, we used bibliometrics to explore the literature on VR and pain control, with the aim of identifying research progress and predicting future research hot spots.
METHODS
We extracted literature on VR and pain control published between 2000 and 2022 from the Web of Science Core Collections and conducted bibliometric analyses. We analyzed the publication and citation trends in the past 2 decades, as well as publication and citation analyses of different countries, institutions, journals, and authors. For references, we conducted cocitation and burst analyses. For keywords, we conducted co-occurrence, clustering, timeline view, and citation burst analyses.
RESULTS
Based on 1176 publications, we found that there was a continuous increase in publication and citation volumes, especially in the last 5 years. The United States was the most representative country, and the University of Washington was the most representative institution, with both having the most publications and citations. The most popular journal in this field was Burns, and Hoffman HG was the most productive author, leading many studies on patients with burn pain. The reference with the most citation burst was a study on the verification of new hardware in pain control. The keywords with the highest citation bursts related to various situations of pain such as "burn pain," "wound care," "low back pain," and "phantom limb."
CONCLUSIONS
VR has been applied in various clinical situations for pain management, among which burns and pediatric surgery have achieved satisfactory results. We infer that VR will be extended to more clinical pain situations in the future, such as pain control in wound care, low back pain, and phantom limb pain. New research hot spots will include the development of software and hardware to improve the immersive experience of VR for pain control. However, our work was based solely on English literature from the Web of Science database. For future studies, we recommend that researchers explore literature from multiple databases to enhance the scope of their research.
PubMed: 37991981
DOI: 10.2196/48354 -
Bone & Joint Open Nov 2023The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the...
AIMS
The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.
METHODS
The MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest.
RESULTS
Three studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184).
CONCLUSION
Rotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
PubMed: 37907080
DOI: 10.1302/2633-1462.411.BJO-2023-0101.R1