Assessing the therapeutic role of trehalose and hyaluronic acid: implications for patient care.

OBJECTIVE: This Systematic review aims to assess the efficacy of trehalose and hyaluronic acid in enhancing ocular recovery post-cataract surgery, focusing on their impact on tear film stability, ocular surface integrity, and patient-reported outcomes. METHODS: A comprehensive search was conducted across MEDLINE, PubMed, and Cochrane Library databases to identify randomized controlled trials investigating the efficacy of trehalose, hyaluronic acid, or their combination in post-cataract surgery care. The inclusion criteria focused on peer-reviewed studies in English, detailing outcomes relevant to ocular recovery such as tear film stability, ocular surface integrity, patient-reported discomfort, or visual acuity (VA). The quality of the included studies was assessed using the Cochrane Risk of Bias Tool and synthesized the data qualitatively. RESULTS: Four qualitative investigations met the inclusion criteria. The studies collectively assessed the efficacy of a 3% trehalose and 0.15% hyaluronic acid eye drop solution in reducing postoperative eye symptoms compared to various control solutions. Parameters measured included tear break-up time (TBUT), Fluorescein staining, tear production (Schirmer test), and Ocular Surface Disease Index (OSDI) scores. The results indicated significant improvements in tear film stability and ocular surface health for the treatment groups compared to controls, with a notable decrease in patient-reported discomfort. The study showed an improvement of - 18 (± 14.6) in the treatment group compared to - 7 (± 8.0) in the control group for OSDI. For TBUT, the treatment group improved by 3 (± 1.2) s, whereas the control group improved by 0.3 (± 0.71) s. VA, measured on a scale of 0-100, increased to 17 (± 0.7) in the treatment group compared to 15 (± 1.1) in the control group. CONCLUSIONS: Trehalose and hyaluronic acid may be beneficial in the postoperative period by enhancing tear film stability and ocular surface health. While the results are promising, further research is needed to confirm these findings, understand the mechanisms of action, and explore broader applications.

Optimizing postsurgical recovery for elderly patients with gastric cancer.

Based on a recent study by Li et al, this editorial examines the significance of enhanced recovery after surgery (ERAS) protocols for elderly patients with gastric cancer. Cancer-related mortality, which is overwhelmingly caused by gastric cancer, calls for effective treatment strategies. Despite advances in the field of oncology, conventional postoperative care often results in prolonged hospital stays and increased complications. The aim of ERAS is to expedite recovery, reduce surgical stress, and improve patient satisfaction. The study of Li et al showed that, compared to traditional care, ERAS significantly reduces mortality risk, shortens hospital stays, and decreases postoperative complications. These findings support the widespread implementation of ERAS protocols in surgical practice to enhance patient outcomes and healthcare value.

The effect of intraoperative goal-directed fluid therapy in patients under anesthesia for gastrointestinal surgery.

BACKGROUND: Intraoperative fluid management is an important aspect of anesthesia management in gastrointestinal surgery. Intraoperative goal-directed fluid therapy (GDFT) is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time. AIM: To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery. METHODS: This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital. The experimental group (GDFT group) and the control group, each comprising 30 patients, received intraoperative GDFT and traditional fluid management strategies, respectively. The effect of GDFT was evaluated by comparing postoperative recovery, complication rates, hospitalization time, and other indicators between the two patient groups. RESULTS: Intraoperative blood loss in the experimental and control groups was 296.64 ± 46.71 mL and 470.05 ± 73.26 mL (P < 0.001), and urine volume was 415.13 ± 96.72 mL and 239.15 ± 94.69 mL (P < 0.001), respectively. The postoperative recovery time was 5.44 ± 1.1 days for the experimental group compared to 7.59 ± 1.45 days (P < 0.001) for the control group. Hospitalization time for the experimental group was 10.87 ± 2.36 days vs 13.65 ± 3 days for the control group (P < 0.001). The visual analogue scale scores of the experimental and control groups at 24 h and 48 h post-surgery were 3.38 ± 0.79 and 4.51 ± 0.86, and 2.05 ± 0.57 and 3.51 ± 0.97 (P < 0.001), respectively. The cardiac output of the experimental and control groups was 5.99 ± 1.04 L/min and 4.88 ± 1.17 L/min, respectively, while the pulse pressure variability for these two groups was 10.87 ± 2.36% and 17.5 ± 3.21%, respectively. CONCLUSION: The application of GDFT in gastrointestinal surgery can significantly improve postoperative recovery, reduce the incidence of complications, and shorten hospital stays.

Usefulness of automated tractography for outcome prediction in patients with recurrent stroke.

[Purpose] To examine the usefulness of automated tractography for predicting outcomes in patients with recurrent stroke. [Participants and Methods] Diffusion tensor imaging was performed in the second week after stroke, and fractional anisotropy was calculated using automated tractography. Three patients with recurrent strokes were included in this study. [Results] Initial computed tomography findings of a 62-year-old man with stuttering speech revealed a hemorrhage in the left thalamus. Fractional anisotropy indicated slight neural damage in the association fibers of both hemispheres. The patient returned to work with mild attention deficit and aphasia. Initial diffusion-weighted imaging of a 75-year-old man with right upper extremity paresis showed high-intensity areas in the left corona radiata. Fractional anisotropy indicated bilateral neural damage to the corticospinal tract. The patient was discharged with severe right upper extremity impairment and a modified gait. Initial diffusion-weighted imaging of a 60-year-old woman with moyamoya disease who experienced a sudden loss of consciousness showed high-intensity areas in the left anterior circulation territories. Fractional anisotropy indicated severe damage to the right hemisphere, the corticospinal tract, and the superior longitudinal fasciculus of the left hemisphere. She was transferred to a nursing home and remained bedridden. [Conclusion] The symptoms identified in this study agreed with automated tractography findings, which suggests that this methodology is useful for predicting recurrent stroke outcomes.

Multidisciplinary Delphi Panel on Rehabilitation Approaches and Unmet Needs for Chronic Stroke Walking Impairment and the Role of Rhythmic Auditory Stimulation.

INTRODUCTION: Walking or gait impairment is a common consequence of stroke that persists into the chronic phase of recovery for many stroke survivors. The goals of this work were to obtain consensus from a multidisciplinary panel on current practice patterns and treatment options for walking impairment after stroke, to better understand the unmet needs for rehabilitation in the chronic phase of recovery and to explore opportunities to address them, and to discuss the potential role of rhythmic auditory stimulation (RAS) in gait rehabilitation. METHODS: A panel of eight experts specializing in neurology, physical therapy, and physiatry participated in this three-part, modified Delphi study. Survey 1 focused on gathering information to develop statements that were discussed and polled during Survey 2 (interactive session), after which revised and new statements were polled in Survey 3. Consensus was defined as ≥75% (6/8 of panelists) agreement or disagreement with a statement. RESULTS: Consensus agreement was ultimately reached on all 24 statements created and polled during this process. The panelists agreed that individuals with gait or walking impairment in the chronic phase of stroke recovery can achieve meaningful improvement in walking by utilizing various evidence-based interventions. Barriers to treatment included cost, access, participation in long-term treatment, and safety. Consensus was achieved for interventions that have the following features challenging, personalized, accessible, and engaging. Improvement of gait speed and quality, durability of effect, safety, affordability, and ability for home or community use also emerged as important treatment features. In addition to conventional treatments (e.g., physical therapy, including mobility-task training and walking/exercise therapy), RAS was recognized as a potentially valuable treatment modality.  Discussion: This panel highlighted limitations of current treatments and opportunities to improve access, participation, and outcomes through a consideration of newer treatment strategies and patient/healthcare provider education and engagement.

Effect of a honey-sweetened beverage on muscle soreness and recovery of performance after exercise-induced muscle damage in strength-trained females.

Background: This study explores a novel approach to mitigating delayed-onset muscle soreness (DOMS), a common issue among strength-trained females. By investigating the potential of a honey-sweetened beverage, which contains anti-inflammatory properties, we aim to enhance muscle recovery after exercise-induced muscle damage (EIMD). Method: A randomized, cross-over, placebo-controlled, and double-blinded study was conducted with sixteen female strength athletes. Firstly, the baseline measurements were recorded, and participants were randomly divided into two conditions: honey-sweetened beverage (HSB; 70 g of honey in 250 mL water with a concentration of 28%) and placebo (PLA; 250 mL of water with 70 g of artificial sweetener). The HSB and PLA were consumed 90 min before the EIMD started (200 vertical jumps with 10% body-weighted vests). Recovery monitoring of performance indicators and DOMS was performed after EIMD. The results of wall-sit, V-Sit and reach flexibility test (VSFT), vertical jump height (VJH), pressure pain threshold (PPT), and one repetition maximum (IRM) tests were recorded 48 h after EIMD. Also, DOMS was recorded using the visual analog scale (VAS) before the start of the test and immediately, 12, 24, and 48 h after EIMD. A one-week interval was considered a washout period for each condition. The collected data were analyzed by repeated measures of ANOVA and Bonferroni post hoc test and dependent t-test at P ≤ 0.05 level. Results: Compared to PLA, HSB ingestion improves wall-sit performance (p = 0.003), 1RM (p = 0.019), and RPE (p = 0.003) after EIMD. However, no significant differences were observed between BL, PLA, and HSB in VJH (p = 0.384), VSFT (p = 0.840), and PPT (p = 0.151) after EIMD. Furthermore, HSB, compared to PLA, considerably decreased the values of DOMS immediately, 12, 24, and 48 h after EIMD (p < 0.05). Conclusion: Our findings illustrated that ingesting HSB in strength-trained females can be a helpful strategy for improving recovery indicators such as muscle strength, endurance, and muscle soreness after EIMD.

The Impact of Bispectral Index Monitoring on Outcomes in Spinal Cord Stimulation for Chronic Disorders of Consciousness.

Objective: To observe whether maintaining the appropriate depth of anesthesia with Bispectral Index (BIS) can improve the prognosis of Spinal Cord stimulation (SCS) implantation in patients with chronic Disorders of consciousness (DoC). Methods: 103 patients with DoC undergoing SCS implantation were reviewed, and 83 patients with DoC were included according to the standard of inclusion and exclusion Criteria. Patients were divided into a BIS group (n =45) and a non-BIS group (n =38) according to whether BIS monitoring was used during the operation. The depth of anesthesia in the BIS group was maintained between 40-60. The anesthesiologist adjusted the depth of anesthesia in the non-BIS group according to clinical experience. Relevant information such as disease course, cause, anesthesia time, and operation time were collected. Preoperative CRS-R(preoperative) score, postoperative CRS-R(24h), and postoperative CRS-R(3m) changes were collected. Results: The CRS-R(3m) score in the BIS group was higher than that in the non-BIS group (preoperative), and the difference was statistically significant (P < 0.05). In CRS-R (24h), the BIS group was higher than the non-BIS group, and the difference was statistically significant (X2=8.787, P =0.004). The improvement of consciousness was included in the multivariate Logistic regression analysis model, and it was found that the thalamus was an independent factor affecting the improvement of consciousness (P < 0.05). During follow-up, 1 patient in the BIS group had a decrease in consciousness from MCS- to VS/ UWS and 2 patients in the non-BIS group died during follow-up. Conclusion: Patients can be benefit in hearing in CRS-R (24h). We recommend the use of BIS to monitor the depth of anesthesia in patients with DoC to improve patient outcomes.

Pulsed Electromagnetic Field (PEMF) stimulation as an adjunct to exercise: a brief review.

Pulsed Electromagnetic Field (PEMF) therapy is a non-invasive treatment that utilizes electromagnetic fields to stimulate and promote natural healing processes within the body. PEMF therapy works by emitting low-frequency electromagnetic pulses, which penetrate deep into tissues and cells, enhancing cellular function and health. PEMF applications are vast, ranging from enhancing recovery in athletes to supporting overall well-being in everyday individuals. PEMF therapy is increasingly recognized in the realm of sports and physical activity for its profound benefits in enhancing performance, accelerating recovery, and preventing injuries. By improving circulation, enhancing tissue oxygenation, and promoting the body's natural healing processes, PEMF therapy has become an invaluable tool in sports medicine, contributing to optimized physical health and prolonged athletic careers. In this review, we explore the effects of PEMF on exercise and the underlying physiological mechanisms.

Recovery of the hibernating cavernosum by penile revascularization.

Objective: Chronic ischemia-related cavernous dysfunction is considered irreversible. However, in certain patients, cavernous function appears to recover with penile revascularization. In this study, we investigated a potential cavernous dysfunction reversibility from a clinical perspective. Patients and Methods: We involved 93 young patients in the study with arterial erectile dysfunction (ED) (median age: 30 years). Erectile function tests were performed according to the standard operating procedures of the International Society of Sexual Medicine. Among the participants, 63 and 30 displayed pure arteriogenic and mixed vasculogenic (due to both arterial insufficiency and cavernous dysfunction) ED, respectively. Penile revascularization was performed by anastomosing the inferior epigastric artery to the dorsal artery. The ED treatment success was considered from a score of at least 24 on the International Index of Erectile Function-6. Results: Our results proved that penile revascularization cured 92.1% and 73.8% of the patients with pure arteriogenic and mixed vasculogenic ED, respectively (Kaplan-Meier method, log-rank test: no significant difference). The required time for curing 50% of the patients was 10.5 and 10.0 months for pure arteriogenic and mixed vasculogenic ED, respectively, indicating no recovery delay in patients with mixed vascular ED. Furthermore, the cavernous dysfunction degree did not influence cavernous function recovery. Conclusion: Penile revascularization cured ED in 73.8% of the patients with mixed vasculogenic ED. Cavernous dysfunction appears to be reversible in certain cases. Furthermore, we observed no delay in functional recovery compared to participants with healthy cavernous function. These two discoveries suggest that cavernous function recovery after penile revascularization is similar to the concept of hibernating myocardium in ischemic myocardium. Although cavernous dysfunction is considered irreversible, it could be reversed in multiple cases with blood flow restoration to the cavernous tissue.

Application of biosurfactants in enhanced oil recovery ex-situ: a review.

With a growing focus on environmentally friendly solutions, biosurfactants derived from plants or microorganisms have gained attention for Enhanced Oil Recovery (EOR) applications. Biosurfactants offer several advantages over existing options, including biodegradability, low toxicity, availability of raw materials, resistance to harsh reservoir conditions, and improved water/oil interfacial tension reduction. Different organisms, such as bacteria, fungi, and plants, can produce these natural surfactants. Bacillus sp. and Pseudomonas sp. bacteria are extensively studied for their ability to produce biosurfactants using low-cost carbon and nitrogen sources, exhibiting excellent surface activity and low critical micellar concentration (CMC). Fungi, though less commonly used, can also produce biosurfactants, albeit with lower interfacial activity. Plant-derived natural surfactants find wide application in laboratory tests for EOR, despite having higher CMC. This review not only summarizes the current knowledge on biosurfactants but also offers a novel comparative analysis of those produced by bacteria, fungi, and plants, examining their CMC, surface tension, and interfacial tension properties. Additionally, it quantifies the number of publications on the use of biosurfactants for Microbial Enhanced Oil Recovery ex-situ (MEOR ex-situ) over the past 30 years and compares these with biosurfactants derived from plant sources. Our study is unique in its comparative approach and the quantification of literature on MEOR ex-situ. The findings reveal that biosurfactants produced by bacteria generally exhibit superior surface activity, even at lower concentrations, compared to those produced by plants or fungi. This new comparative perspective and thorough literature analysis highlight the distinctive contributions of this study. Overall, the use of biosurfactants for EOR represents a promising approach to cleaner energy production, with the potential to reduce environmental impact while improving oil recovery.

Exploring the cessation process from adolescence to young adulthood in individuals with lived experience of nonsuicidal self-injury: a qualitative study.

INTRODUCTION: Nonsuicidal self-injury (NSSI) is a common and concerning behavior in adolescents. However, most adolescents cease NSSI as they transition into adulthood. Increased knowledge of the cessation process is needed. This study aimed to qualitatively explore the factors contributing to NSSI cessation in individuals with lived experience of NSSI, providing valuable insights for treatment strategies. METHODS: Twenty-six individuals assigned female sex at birth, between ages 20-22 years, from Sweden were interviewed between 2021 and 2023 in Linköping, Sweden. Of these, 21 individuals perceived themselves as having ceased NSSI and were included in the analysis. Thematic analysis and Hooley and Franklins' Benefits and Barriers Model of NSSI were used to analyze the transcripts. RESULTS: Three overarching themes were generated: "Something inside me changed", "Something in my close relationships changed", and "Something in my life context changed". The cessation of NSSI was associated with several key factors. Improved well-being and envisioning a different future were pivotal in initiating the cessation process. Additionally, interpersonal relationships and support from others were interpreted as powerful motivators for change. Transitioning to a new social context and leaving behind a destructive environment provided opportunities for personal growth and enhanced well-being, interpreted as initiators in the participants' broader life context. CONCLUSION: This study underscores the complexity of the NSSI cessation process and highlights the need for a comprehensive understanding of the underlying factors. Access to emotion regulation skills was perceived as a significant barrier to NSSI engagement. Clinical implications and different interventions to support NSSI cessation are discussed.

Accelerated 2D radial Look-Locker T1 mapping using a deep learning-based rapid inversion recovery sampling technique.

Efficient abdominal coverage with T1-mapping methods currently available in the clinic is limited by the breath hold period (BHP) and the time needed for T1 recovery. This work develops a T1-mapping framework for efficient abdominal coverage based on rapid T1 recovery curve (T1RC) sampling, slice-selective inversion, optimized slice interleaving, and a convolutional neural network (CNN)-based T1 estimation. The effect of reducing the T1RC sampling was evaluated by comparing T1 estimates from T1RC ranging from 0.63 to 2.0 s with reference T1 values obtained from T1RC = 2.5-5 s. Slice interleaving methodologies were evaluated by comparing the T1 variation in abdominal organs across slices. The repeatability of the proposed framework was demonstrated by performing acquisition on test subjects across imaging sessions. Analysis of in vivo data based on retrospectively shortening the T1RC showed that with the CNN framework, a T1RC = 0.84 s yielded T1 estimates without significant changes in mean T1 (p > 0.05) or significant increase in T1 variability (p > 0.48) compared to the reference. Prospectively acquired data using T1RC = 0.84 s, an optimized slice interleaving scheme, and the CNN framework enabled 21 slices in a 20 s BHP. Analyses across abdominal organs produced T1 values within 2% of the reference. Repeatability experiments yielded Pearson's correlation, repeatability coefficient, and coefficient of variation of 0.99, 2.5%, and 0.12%, respectively. The proposed T1 mapping framework provides full abdominal coverage within a single BHP.

Implementation of a Multidisciplinary Enhanced Recovery After Surgery (ERAS) Program for Cytoreductive Surgery (CRS) With Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

BACKGROUND AND OBJECTIVES: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can be associated with prolonged hospital stays. A novel Enhanced Recovery After Surgery (ERAS) based on ERAS Society guidelines was designed and implemented. The primary outcome was ERAS compliance. Secondary outcomes included length of stay (LOS) and postoperative complications. METHODS: A retrospective study on patients who underwent CRS/HIPEC between 2018 and 2022, with ERAS implementation in 2022. Health records were reviewed. Statistical analysis included descriptive statistics, Wilcoxon tests, Student t-test, and χ2 and binomial negative regression. Health Ethics Research Board approval was obtained. RESULTS: Eighty patients underwent CRS/HIPEC: 59 in the pre-ERAS group and 21 in the post-ERAS group. Groups were similar in age, comorbidities, and Peritoneal Carcinomatosis Index. ERAS compliance increased from 32.8% to 70.8% (p < 0.001). Median LOS decreased from 14 to 9 days (p < 0.001). Comparing pre-ERAS to post-ERAS showed no significant difference in the major morbidity rate (13.6% vs. 9.5%) or 30-day readmission (9.4% vs. 4.8%) and no mortalities. Controlling for patient characteristics, the mean LOS decreased by 6.94 days (p < 0.001). CONCLUSION: Implementation of an ERAS CRS/HIPEC program is safe and allows for improved compliance to ERAS protocols and a significant reduction in LOS.

Innovative process for sulphur recovery from waste incineration flue gases: production of marketable sodium bisulphite solution.

This study presents an innovative process for recovering sulphur from hazardous waste incineration flue gases, designed to produce a marketable sodium bisulphite solution while ensuring complete SO2 removal. This new process is characterized by a double absorption strategy at two different pH levels. The first step, at an acidic pH, generates the desired bisulphite solution, while the second step, at a basic pH, produces the sulphite solution for recycling into the first step and ensures total SO2 removal. The process's performance and feasibility were evaluated on a laboratory scale using a batch reactor with synthetic gas. The parametric study focused on the initial sulphite concentration in the absorption solution and the reactor temperature. A removal efficiency exceeding 95% was achieved across all initial sulphite concentrations and temperature ranges, when the pH was maintained above 6. At pH 5, where bisulphites are the predominant sulphur species, the removal efficiency remained substantial at approximately 70%. The oxidation of sulphites/bisulphites by oxygen in the flue gases was minimal, with less than 5% conversion to sulphate. Additionally, pH-controlled experiments were conducted to optimize plant start-up procedures. For the basic reactor, starting with water and adjusting the pH to 8 during SO2 absorption effectively minimized sodium hydroxide consumption. In contrast, for the acidic reactor at pH 5, initiating the process with a concentrated sulphite solution resulted in more stable absorption rates. These findings underscore the process's potential for efficient sulphur recovery and highlight the importance of pH management in optimizing operational stability and chemical consumption.

A Case Report on a Women's Residential Substance use Program in a Rural and Urban Setting.

PURPOSE: To describe program characteristics and outcomes of a residential substance use recovery program serving pregnant and parenting women in a rural and urban location. DESCRIPTION: This assessment of administrative records from April 1, 2020 through March 31, 2022, included women in a rural (n = 140) and urban (n = 321) county in Kentucky. ASSESSMENT: This retrospective case study used descriptive and non-parametric analyses to assess the population and examine differences between locations, race, and ethnicity for women served. Logistic regression tested predictors of goal achievement by community. Of 461 women served, 65 (14.1%) delivered a baby while in treatment; 62 of which were considered healthy. 13% of the women were Black, 83.1% non-Hispanic (NH) white, and 3.7% were other races/biracial; 1.3% were Hispanic. The mean age was 30.92 years (SD 6.23) and treatment duration was 90.11 days (SD 67.70). Program goals were achieved by 312 (67.7%). There were no differences in rates of goal achievement or treatment duration by race, ethnicity, or age and no difference in the rate of achievement by location in univariate analyses. However, treatment duration was positively associated with program success in both communities. In the urban community, Black women were 8% more likely to successfully complete the program compared to NH white women (OR = 9.77 [95% CI 1.21,79.18; p = 0.033]) after controlling for confounders. Insufficient sample size for non-white women in the rural community prohibited evaluation. CONCLUSIONS: Duration of time in the program best predicted successful completion for women in recovery. These findings have policy implications.

Silicone granuloma with intact breast implants: A case report.

Silicone granuloma formation is a potential complication of silicone implant rupture. Breast magnetic resonance imaging (MRI) is a useful diagnostic tool to assess implant integrity and complications; however, there can be overlap in the enhancement pattern of silicone granuloma and malignancy. We present the case of an 85 year old with suspicious axillary masses on clinical exam for which MRI was recommended. MRI demonstrated enhancing masses in the right axilla that were suspicious for malignancy and biopsy was ultimately performed. This case discusses the use of inversion recovery sequences on MRI, as well as ultrasound, to differentiate malignancy from silicone granuloma formation to prevent unnecessary biopsies.

Changes in interpersonal violence and utilization of trauma recovery services at an urban trauma center in the United States during the COVID-19 pandemic: a retrospective, comparative study.

Purpose: This study investigated changes in interpersonal violence and utilization of trauma recovery services during the COVID-19 pandemic. At an urban level I trauma center, trauma recovery services (TRS) provide education, counseling, peer support, and coordination of rehabilitation and recovery to address social and mental health needs. The COVID-19 pandemic prompted considerable changes in hospital services and increases in interpersonal victimization. Methods: A retrospective analysis was conducted between September 6, 2018 and December 20, 2020 for 1,908 victim-of-crime patients, including 574 victims of interpersonal violence. Outcomes included length of stay associated with initial TRS presentation, number of subsequent emergency department visits, number of outpatient appointments, and utilization of specific specialties within the year following the initial traumatic event. Results: Patients were primarily female (59.4%), single (80.1%), non-Hispanic (86.7%), and Black (59.2%). The mean age was 33.0 years, and 247 patients (49.2%) presented due to physical assault, 132 (26.3%) due to gunshot wounds, and 76 (15.1%) due to sexual assault. The perpetrators were primarily partners (27.9%) or strangers (23.3%). During the study period, 266 patients (mean, 14.9 patients per month) presented before the declaration of COVID-19 as a national emergency on March 13, 2020, while 236 patients (mean, 25.9 patients per month) presented afterward, representing a 74.6% increase in victim-of-crime patients treated. Interactions with TRS decreased during the COVID-19 period, with an average of 3.0 interactions per patient before COVID-19 versus 1.9 after emergency declaration (P<0.01). Similarly, reductions in length of stay were noted; the pre-COVID-19 average was 3.6 days, compared to 2.1 days post-COVID-19 (P=0.01). Conclusions: While interpersonal violence increased, TRS interactions decreased during the COVID-19 pandemic, reflecting interruption of services, COVID-19 precautions, and postponement/cancellation of elective visits. Future direction of hospital policy to enable resource and service delivery to this population, despite internal and external challenges, appears warranted.

The Role of Electrical Stimulation in Peripheral Nerve Regeneration: Current Evidence and Future Directions.

The role of electrical stimulation in peripheral nerve regeneration is reviewed, including a brief background and proposed mechanism of action. Studies in animal as well as human models are reviewed. Current recommendations and future directions are addressed.