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BJR Open Jan 2024In a clinical study, diffusion kurtosis imaging (DKI) has been used to visualize and distinguish white matter (WM) structures' details. The purpose of our study is to...
OBJECTIVES
In a clinical study, diffusion kurtosis imaging (DKI) has been used to visualize and distinguish white matter (WM) structures' details. The purpose of our study is to evaluate and compare the diffusion tensor imaging (DTI) and DKI parameter values to obtain WM structure differences of healthy subjects.
METHODS
Thirteen healthy volunteers (mean age, 25.2 years) were examined in this study. On a 3-T MRI system, diffusion dataset for DKI was acquired using an echo-planner imaging sequence, and T-weghted (Tw) images were acquired. Imaging analysis was performed using Functional MRI of the brain Software Library (FSL). First, registration analysis was performed using the Tw of each subject to MNI152. Second, DTI (eg, fractional anisotropy [FA] and each diffusivity) and DKI (eg, mean kurtosis [MK], radial kurtosis [RK], and axial kurtosis [AK]) datasets were applied to above computed spline coefficients and affine matrices. Each DTI and DKI parameter value for WM areas was compared. Finally, tract-based spatial statistics (TBSS) analysis was performed using each parameter.
RESULTS
The relationship between FA and kurtosis parameters (MK, RK, and AK) for WM areas had a strong positive correlation (FA-MK, = 0.93; FA-RK, = 0.89) and a strong negative correlation (FA-AK, = 0.92). When comparing a TBSS connection, we found that this could be observed more clearly in MK than in RK and FA.
CONCLUSIONS
WM analysis with DKI enable us to obtain more detailed information for connectivity between nerve structures.
ADVANCES IN KNOWLEDGE
Quantitative indices of neurological diseases were determined using segmenting WM regions using voxel-based morphometry processing of DKI images.
PubMed: 38352183
DOI: 10.1093/bjro/tzad003 -
Brain and Behavior Feb 2024The assessment of the normative values of sensory nerve action potentials (SNAP) and their diagnostic accuracies using validated neuropathy-assessment tools to classify...
Values and diagnostic accuracy of sensory nerve action potentials in control participants and participants with diabetes with and without clinical diabetic neuropathy, based on neuropathy scale measurements.
BACKGROUND
The assessment of the normative values of sensory nerve action potentials (SNAP) and their diagnostic accuracies using validated neuropathy-assessment tools to classify participants into groups with and without neuropathy was not previously described in the literature.
METHODS
The Utah Early Neuropathy Scale (UENS), Michigan neuropathy-screening instrument, and nerve conduction data were collected prospectively. We described and compared the values of the sural, superficial peroneal sensory (SPS), and superficial radial SNAP amplitude in different age groups for three groups. Group 1 (G1)-control participants (UENS <5), group 2 (G2)-participants with diabetes without clinical diabetic neuropathy (UENS <5), and group 3 (G3)-participants with clinical diabetic neuropathy (UENS ≥5). We also described the diagnostic accuracy of single-nerve amplitude and a combined sensory polyneuropathy index (CSPNI) that consists of four total points (one point for each of the following nerves if their amplitude was <25% lower limit of normal: right sural, left sural, right SPS, and left SPS potentials).
RESULTS
We assessed 135 participants, including 41, 37, and 57 participants in G1, G2, and G3, respectively, with age median (interquartile ranges) of 51 (45-56), 47 (38-56), and 54 (51-61) years, respectively, whereas 19 (46.3%), 18 (48.7%), and 32 (56.14%) of them were males, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) scores were 68.4%, 92.3%, 86.7%, and 80% for the sural amplitude; 86%, 58.3%, 62%, and 84% for the SPS amplitude; 66.7%, 94.4%, 90.5%, and 78.2% for the CSPNI of 3; and 54.4%, 98.6%, 96.9%, and 73.2% for the CSPNI of 4, respectively.
CONCLUSION
Sural nerve had a high specificity for neuropathy; however, the CSPNI had the highest specificity and PPV, whereas the SPS had the highest sensitivity and NPV.
Topics: Male; Humans; Female; Diabetic Neuropathies; Action Potentials; Neural Conduction; Sural Nerve; Evoked Potentials; Polyneuropathies; Diabetes Mellitus
PubMed: 38351301
DOI: 10.1002/brb3.3423 -
JBJS Essential Surgical Techniques 2024The flexor pronator slide is an effective treatment option for ischemic contracture and contracture related to spastic cerebral palsy, but little is known about the use...
BACKGROUND
The flexor pronator slide is an effective treatment option for ischemic contracture and contracture related to spastic cerebral palsy, but little is known about the use of the flexor pronator slide in other non-ischemic contractures. I propose a flexor pronator slide to simultaneously correct wrist and finger flexor contractures and preserve the muscle resting length. To avoid overcorrection of the deformity, I propose the use of a wide-awake local anesthesia with no tourniquet (WALANT) procedure, in which the patient is able to continually assist the surgeon in assessing the contracture release and improvement in finger movement. Additionally, the WALANT flexor pronator slide releases the specific muscles responsible for wrist and finger contractures (i.e., the flexor digitorum profundus, flexor carpi ulnaris, flexor carpi radialis, flexor digitorum superficialis, and pronator teres), sparing the intact finger functions.
DESCRIPTION
The patient in the video received a WALANT injection of 1% lidocaine with 1:100,000 epinephrine and 8.4% sodium bicarbonate in the operating room, and surgery was started 30 minutes after the injection to obtain the maximum hemostatic effect. The injections were performed from proximal to distal along the volar-ulnar skin markings from the distal upper arm to the distal third of the forearm. The total volume utilized in this patient was <7 mg/kg (approximately 100 mL). A 25 or 27-gauge needle was infiltrated under the skin at the medial aspect of the elbow and in the distal and proximal forearm fascia. A total of 25 to 40 mL anesthetic was injected at each site, which serves to numb the ulnar nerve. over the volar-radial and volar side of the mid-forearm and distal forearm to numb the median nerve. For the WALANT procedure, an additional 8 mg of dexamethasone was added as an adjuvant to prolong the analgesia and the duration of the nerve block. The skin incision was made over the ulnar border of the forearm, extending proximally just posterior to the medial epicondyle up to the distal third of the upper arm. The origin of the flexor carpi ulnaris was elevated first, then the flexor digitorum profundus and flexor digitorum superficialis were mobilized from the ulna and the interosseous membrane. The release continued in an ulnar-to-radial direction. The patient was awake throughout the procedure, so that the improvement in the contracture could be better assessed. Further dissection around the ulnar nerve was done to release the arcade of Struthers, the Osborne ligament, and the triceps fascia in order to prevent ulnar nerve kinking during anterior transposition. The medial epicondyle was identified, and the flexor pronator wad was released meticulously without joint capsule perforation and medial collateral ligament injury. The muscles were finally examined for contracture in full wrist and finger extension, and further release was performed if remaining contracture was observed. All released muscles were tension-free, suspended on the trunks and branches of the median nerve, ulnar nerve, and radial and ulnar arteries. The ulnar nerve was transposed anteriorly to the medial epicondyle. The subcutaneous tissues were sutured with an absorbable suture, and the skin was closed with the same suture in a subcuticular fashion with a drain.
ALTERNATIVES
Fractional or Z-lengthening of the flexor tendons is the alternative for finger and wrist flexion contractures.
RATIONALE
This patient had previously undergone multiple flexor tendon surgeries in the hand and forearm. The patient developed tight ring, middle, and little finger contractures that could not be passively extended with the wrist in neutral or dorsiflexion. This patient could not extend the proximal or distal interphalangeal joints of the middle, ring, and little finger in wrist extension. Conversely, wrist flexion extended all fingers. When the surgeon tried to extend the fingers with the wrist in extension, excessive force was required and a jog in the movement was appreciated in all small joints. This denoted contractures of the long flexors and flexor tendons of the forearm. Fractional or Z-lengthening may release the flexion contracture in such cases, but leads to loss of active flexion, disrupts the muscle resting length, and causes loss of flexion strength. Because our patient had very tight finger contractures, they were deemed not amenable to fractional or Z-lengthening. Therefore, we preferred the use of a flexor pronator slide to simultaneously correct wrist and finger flexor contractures while preserving the muscle resting length. To avoid overcorrection of the deformity, we preferred to perform a WALANT procedure, during which the patient could continually assist the surgeon in assessing the contracture release and improvement in finger movement. This patient returned to her computer job after the surgery.
EXPECTED OUTCOMES
The flexor pronator slide is an effective treatment option for ischemic contracture and contracture related to spastic cerebral palsy. In 1923, Page described the flexor pronator slide as a surgical option for the late management of compartment syndrome. He noted that the procedure allowed extensive correction of the flexion contracture with less impact on the muscle resting length compared with alternative procedures. Sharma and Swamy noted good hand function in 14 (74%) of 19 patients and an average grip strength of 75% of the contralateral hand following a flexor pronator slide for the treatment of moderate Volkmann contracture. A flexor pronator slide will simultaneously correct wrist and finger flexor contractures and preserve muscle resting length. To avoid overcorrection of the deformity, the flexor pronator slide can be performed as a WALANT procedure, during which the patient is able to continually assist the surgeon in assessing the contracture release and improvement in finger movement. Additionally, a WALANT flexor pronator slide releases the specific muscles responsible for wrist and finger contractures, sparing intact muscles. Good functional outcomes are expected, with a full return to work by 3 months postoperatively. Major complications, such as overcorrection of the deformity, anterior interosseous neurovascular bundle injury, ulnar nerve injury, and wound dehiscence, are unexpected for this procedure.
IMPORTANT TIPS
The treatment for a non-ischemic contracture of the wrist and fingers requires flexor pronator slide surgery to simultaneously correct the deformity without losing the resting muscle length and strength.Both fractional or Z-lengthening and flexor pronator slide surgery for such contractures yield straightforward contracture release. However, maximal preservation of the flexion power and muscle resting strength when releasing these contractures is possible only by shifting the flexor pronator muscles distally without affecting its resting length, which can be achieved by flexor pronator slide.A WALANT flexor pronator slide avoids overcorrection of the deformity because the patient is able to continually assist the surgeon in assessing the contracture release and improvement in finger movement.
ACRONYMS AND ABBREVIATIONS
FCU = flexor carpi ulnarisFCR = flexor carpi radialisWALANT = wide-awake local anesthesia with no tourniquetFPL = flexor pollicis longusDASH = Disabilities of the Arm, Shoulder and HandFDP = flexor digitorum profundusFDS = flexor digitorum superficialis.
PubMed: 38348363
DOI: 10.2106/JBJS.ST.23.00048 -
Frontiers in Neurology 2024Hourglass-like constrictions (HLCs) of peripheral nerves in the upper extremity were a rare form of neuralgic amyotrophy, often characterized by the sudden onset of pain...
Hourglass-like constrictions (HLCs) of peripheral nerves in the upper extremity were a rare form of neuralgic amyotrophy, often characterized by the sudden onset of pain in the shoulder or arm, followed by muscle weakness and amyotrophy, with limited sensory involvement. We present a case of multiple HLCs of the anterior interosseous nerve (AIN) in a 22-year-old female with left upper arm pain, finger numbness, and limited activity for 1 month. Physical examination showed weakness of the left index flexor digitorum profundus and flexor pollicis longus, with mild hypoesthesia in the first three fingers and the radial half of the ring finger. Electromyography suggested a median nerve (mainly AIN) lesion. Ultrasonographic imaging of the median nerve shows AIN bundle swelling and multiple HLCs at left upper arm. Despite conservative treatment, which included 15 days of steroid pulse therapy, Etoricoxib, and oral mecobalamin, the patient still complained of extreme pain at night without relief of any symptoms. Operation was recommended for this patient with thorough concerns of surgical advantages and disadvantages. During surgery, a total of 7 HLCs were found in her median nerve along and above the elbow joint. Only Interfascicular neurolysis was performed because the nerve constrictions were still in the early stage. The pain was almost relieved the next day. One month after surgery, she could bend her thumb and index fingers, although they were still weak. 4 months after the surgery, she was able to bend affected fingers, with muscle strength M3 level. At the same time, her fingers had fewer numbness symptoms. There was still controversy regarding treatment strategy; however, early diagnosis and surgical treatment for nerve HLCs might be a better choice to promote nerve recovery.
PubMed: 38348170
DOI: 10.3389/fneur.2024.1306264 -
Photodiagnosis and Photodynamic Therapy Apr 2024To measure functional, structural, and blood flow parameters of the optic disk in myopic patients with ocular hypertension (OHT) and myopic patients using optical...
OBJECTIVE
To measure functional, structural, and blood flow parameters of the optic disk in myopic patients with ocular hypertension (OHT) and myopic patients using optical coherence tomography angiography (OCTA), this study aims to investigate the variability of each parameter between the two groups, and to analyze the correlation between the RNFL thickness and blood flow parameters, as well as the diagnostic value of these blood flow parameters for myopic patients with OHT.
METHODS
This was a cross-sectional study. Myopic adults who were attending the Eye Center of Jinan Second People's Hospital between December 2020 and January 2022, and who had a confirmed diagnosis of OHT, were enrolled. This cohort constituted the myopic group. In these subjects, retinal nerve fiber layer (RNFL) thickness and blood flow parameters within the superficial optic disk 6 × 6 mm area were measured using OCTA. The optic disk blood flow parameters included radial peripapillary capillaries (RPC) perfusion density (PD) in nasal, temporal, superior, and inferior sectors. Visual field assessments were conducted using a Humphrey visual field meter to obtain the visual field index (VFI) and pattern standard deviation (PSD). SPSS 22.0 statistical software was utilized to determine if statistical differences existed between the parameters of the two groups and to analyze the correlation between blood flow parameters and RNFL thickness. Additionally, the area under the subject's operating characteristic curve (AUROC) was used to assess the diagnostic value of blood flow parameters for myopic patients with OHT.
RESULTS
There was no statistical difference in PSD and VFI in the OHT group compared with the myopic group (P = 0.351, 0.242). The RNFL thickness was (103.64 ± 8.13) μm and (97.56 ± 12.94) μm in the myopic and OHT groups, respectively. There was no statistical difference in RNFL thickness between the OHT and myopic group (P = 0.052). The PD of radial peripapillary capillaries (RPC) in nasal, temporal, superior, and inferior sectors showed an overall decreasing trend between the myopic and OHT groups, but there was a statistical difference only in the temporal sector (P = 0.008). Correlation analysis of blood flow parameters and structural parameters showed that the PD in the temporal sector and RNFL thickness were not correlated (P = 0.263). By plotting the AUROC of blood flow parameter, it was found that OCTA had good value in diagnosing myopic patients with OHT, and the PD of the temporal sector had higher diagnostic value for differentiating the OHT group from myopic group (AUROC = 0.718, P = 0.008) CONCLUSIONS: Compared with the myopic group, blood flow parameters decreased in the OHT group, while structural and functional parameters did not change significantly, suggesting that blood flow damage may have occurred earlier in myopic patients with OHT, by the correlation analysis between structural and blood flow parameters. OCTA has good diagnostic value for myopic patients with OHT.
Topics: Humans; Tomography, Optical Coherence; Cross-Sectional Studies; Myopia; Male; Female; Adult; Middle Aged; Ocular Hypertension; Optic Disk; Microvessels; Optic Nerve; Nerve Fibers
PubMed: 38346468
DOI: 10.1016/j.pdpdt.2024.104013 -
Frontiers in Oncology 2024This aims to investigate the efficacy and safety of intercostal nerve anastomosis among breast cancer patients who undergo immediate subpectoral prosthetic breast...
Efficacy and safety of intercostal nerve anastomosis in immediate subpectoral prosthetic breast reconstruction after nipple-areola-sparing mastectomy: a randomized, controlled, open-label clinical study.
PURPOSE
This aims to investigate the efficacy and safety of intercostal nerve anastomosis among breast cancer patients who undergo immediate subpectoral prosthetic breast reconstruction after nipple-areola-sparing mastectomy.
METHODS
From 2022 to 2023, female patients between the ages of 20 and 60 diagnosed with stage I-IIIA breast cancer, who required and were willing to undergo immediate subpectoral prosthetic breast reconstruction after nipple-areola-sparing mastectomy, were screened and assigned to take the operation with (treatment group) or without (control group) intercostal nerve anastomosis (the nerves with appropriate length and thickness were selected from the 2nd-4th intercostal nerves, which were then dissociated and anastomosed to the posterior areola tissue). A radial incision at the surface projection of the tumor location was used. The patients' breast local sensation was assessed using Semmes-Weinstein monofilaments before the operation as well as at 10 days, 3 months, and 6 months postoperatively. Furthermore, the patients' quality of life was evaluated 6 months postoperatively using the EORTC QLQ-C30 questionnaire. Adverse events, operation duration, drainage volume, and the duration of drainage tube carrying time were also monitored and recorded.
RESULTS
Compared to the pre-operative period, a significant decrease in local sensation was observed 10 days after surgery in both groups. However, the control group showed a significant reduction in sensation at 3 and 6 months postoperatively, while the treatment group showed noticeable recovery. A statistically significant difference ( < 0.001) in local sensation between the pre-operative and post-operative periods was observed at the final follow-up in the two groups. By the time of 3 and 6 months postoperatively, a significant difference was seen in the local sensation between the two groups. Intercostal nerve anastomosis was found to significantly improve the patients' quality of life, including emotional ( = 0.01), physical ( = 0.04), and social functioning ( = 0.02) and pain ( = 0.04). There were no significant differences in general characteristics (such as age, BMI, and subtypes). Although intercostal nerve anastomosis increased the duration of operation by around 20 min ( < 0.001), it did not affect the volume or duration of postoperative drainage tube usage between the two groups.
CONCLUSION
This study indicated that intercostal nerve anastomosis improved the local sensation and quality of life of patients who underwent immediate subpectoral prosthetic breast reconstruction after nipple-areola-sparing mastectomy.
CLINICAL TRIAL REGISTRATION
https://www.chictr.org.cn/showproj.html?proj=42487, identifier ChiCTR1900026340.
PubMed: 38344196
DOI: 10.3389/fonc.2024.1261936 -
Hand Surgery & Rehabilitation Apr 2024Neurogenic thoracic outlet syndrome results from compression of the brachial plexus. The symptoms are mainly pain, upper-limb weakness and paresthesia. Management always...
Neurogenic thoracic outlet syndrome results from compression of the brachial plexus. The symptoms are mainly pain, upper-limb weakness and paresthesia. Management always starts with a rehabilitation program, but failure of rehabilitation may necessitate surgery. In practice, we observed that several patients developed secondary distal nerve entrapment in the months following surgery, with no preoperative compression. We aimed to assess the occurrence of distal nerve entrapment after surgery for neurogenic thoracic outlet syndrome in a retrospective cohort study. Seventy-four patients were included; 82% females; mean age, 39.4 ± 9.4 years. There were 36.5% with high intensity and 63.5% with low to moderate intensity work. Eighteen (24.3%) developed secondary upper-limb entrapment at 10.6 ± 5.8 months after surgery. Sixteen had a single entrapment and 2 had two different entrapments. In 10 cases (50%) the ulnar nerve was involved at the elbow, in 7 (35.0%) the radial nerve at the radial tunnel, and in 3 (15.0%) the median nerve. No differences were found between patients with and without secondary nerve entrapment in gender (p = 0.51), mean age (p = 0.44), symptom duration (p = 0.92) or work intensity (p = 0.26). Further studies are needed to confirm these results and to shed light on the underlying mechanisms.
Topics: Humans; Thoracic Outlet Syndrome; Female; Retrospective Studies; Male; Adult; Nerve Compression Syndromes; Middle Aged; Postoperative Complications; Decompression, Surgical; Cohort Studies
PubMed: 38342235
DOI: 10.1016/j.hansur.2024.101660 -
Journal of Clinical Medicine Jan 2024(1) Pathological humeral shaft fracture (PHSF) is a frequently observed clinical manifestation in the later stages of tumor metastasis. Surgical interventions are... (Review)
Review
(1) Pathological humeral shaft fracture (PHSF) is a frequently observed clinical manifestation in the later stages of tumor metastasis. Surgical interventions are typically recommended to alleviate pain and restore functionality. Intramedullary nail fixation (INF) or plate fixation (PF) is currently recommended for the treatment of PHSF. However, there is still no standard for optimal surgical treatment. Thus, we conducted a meta-analysis comparing the clinical outcomes of INF with PF for PHSF treatment. (2) We conducted searches in databases, such as Scopus, EMBASE, and PubMed, for studies published prior to May 2023. In total, nine studies with 485 patients were reviewed. (3) There were no significant differences noted in the incidence of fixation failure, local recurrence, wound complication or overall complication. However, the INF group demonstrated a significantly lower incidence of postoperative radial nerve palsy than the PF group (OR, 5.246; 95% CI, 1.548-17.774; = 0.008). A subgroup analysis indicated that there were no statistically significant differences in fixation failure or local recurrence among subgroups categorized by the design of intramedullary nail. (4) Considering the short life expectancy of end-stage patients, the choice of surgical method depends on the patient's individual condition, fracture and lesion patterns, the surgeon's experience, and comprehensive discussion between the surgeon and patient.
PubMed: 38337449
DOI: 10.3390/jcm13030755 -
JSES Reviews, Reports, and Techniques Feb 2024Open reduction and internal fixation with plate is one of the most widely used treatments for distal third humeral shaft fractures. The purpose of this study was to...
Treatment of distal third humeral shaft fractures with posterior minimally invasive plate osteosynthesis (MIPO) with segmental isolation of the radial nerve: minimum one-year follow-up.
BACKGROUND
Open reduction and internal fixation with plate is one of the most widely used treatments for distal third humeral shaft fractures. The purpose of this study was to report the outcomes of the treatment of distal third humeral shaft fractures with posterior minimally invasive plate osteosynthesis (MIPO) with segmental isolation of the radial nerve.
METHODS
We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 22 distal third humeral shaft fractures treated with posterior MIPO in our institution with an extra-articular distal humerus plate from 2018 to 2021. Inclusion was limited to functionally independent patients with displaced fractures involving the junction of the middle and distal thirds of the humerus and minimum 12-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; Mayo Elbow Performance Score; and Constant-Murley score.
RESULTS
The average follow-up period of the sample was 31.7 ± 11.6 months (range, 15.7-51.3 months). The average elbow flexion and extension were 146.4° ± 7.3° (range, 120°-150°) and -0.7° ± 3.3° (range, -15° to 0°), respectively. The average shoulder anterior flexion, elevation, and abduction were 178.6° ± 3.6° (range, 170°-180°), 179.1° ± 2.9° (range, 170°-180°), and 140.9° ± 14.8° (range, 110°-160°), respectively. The average external rotation was 88.6° ± 6.4 (range, 65°-90°). The mean visual analog scale score for pain was 1.0 ± 1.6 (range, 0-5) and the mean Mayo Elbow Performance Score was 90.5 ± 9.9 (range, 70-100). The mean QuickDASH and Constant-Murley scores were 4.7 ± 6.8 (range, 0-20.5) and 95.5 ± 5.1 (range, 81-100), respectively. Two patients presented with relevant compromise of radial nerve motor function postoperatively (M3 and M2; the more compromised was preoperative injury). All patients recovered radial nerve neuropraxia within six weeks postoperatively. All fractures achieved union. The average anteroposterior and lateral axis were 175.0 ± 3.6 (168.0°-180.0°) and 177.5 ± 2.0 (173.0°-180.0°), respectively. No superficial or deep infection was reported. No cases of re-displacement of fracture, implant failure, or any other implant-related complication in follow-up were reported. No patient required plate withdrawal.
CONCLUSION
The results of this study demonstrate that the posterior MIPO technique is a reliable option for treating distal third shaft humeral fractures. The radial nerve must be identified and protected in all cases to prevent palsy.
PubMed: 38323209
DOI: 10.1016/j.xrrt.2023.08.006