Ultrasound-Guided Modified Thread Carpal Tunnel Release for Carpal Tunnel Syndrome: A Pilot Study.

PURPOSE: This study aimed to investigate the effectiveness and safety of modified thread carpal tunnel release (mTCTR) using Smartwire-01 in patients with carpal tunnel syndrome (CTS). MATERIALS AND METHODS: Patients with CTS who required CTR were enrolled. Symptom severity and functional status were assessed using the Boston Carpal Tunnel Syndrome Questionnaire-Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), and pain was assessed using a numerical rating scale (NRS) at 4, 8, and 12 weeks after mTCTR. The scores were compared with the pre-procedural scores. The electrophysiologic study and median nerve cross-sectional area (CSA) measurements at the wrist before and 12 weeks after mTCTR were compared. RESULTS: A total of 11 patients were included. No adverse effects were reported throughout the study period. The NRS, BCTQ-SSS, and BCTQ-FSS scores significantly improved at 4 weeks after mTCTR, and this improvement persisted throughout the follow-up period (NRS and BCTQ-SSS, P < 0.001; BCTQ-FSS, P = 0.012). After 12 weeks, the latency and velocity of the median sensory nerve action potential significantly improved, compared with those before mTCTR (latency, 5.4 ± 1.3 to 4.7 ± 1.1 ms, P = 0.01; velocity 27.8 ± 6.8 to 31.8 ± 7.4 m/s, P = 0.019). No significant change was observed in the median nerve CSA before and after mTCTR. CONCLUSION: mTCTR using Smartwire-01 is a safe and effective procedure and a possible alternative to surgery.

Post-Stroke Infections: Insights from Big Data Using Clinical Data Warehouse (CDW).

This study analyzed a digitized database of electronic medical records (EMRs) to identify risk factors for post-stroke infections. The sample included 41,236 patients hospitalized with a first stroke diagnosis (ICD-10 codes I60, I61, I63, and I64) between January 2011 and December 2020. Logistic regression analysis was performed to examine the effect of clinical variables on post-stroke infection. Multivariable analysis revealed that post-stroke infection was associated with the male sex (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.49-2.15), brain surgery (OR: 7.89; 95% CI: 6.27-9.92), mechanical ventilation (OR: 18.26; 95% CI: 8.49-44.32), enteral tube feeding (OR: 3.65; 95% CI: 2.98-4.47), and functional activity level (modified Barthel index: OR: 0.98; 95% CI: 0.98-0.98). In addition, exposure to steroids (OR: 2.22; 95% CI: 1.60-3.06) and acid-suppressant drugs (OR: 1.44; 95% CI: 1.15-1.81) increased the risk of infection. On the basis of the findings from this multicenter study, it is crucial to carefully evaluate the balance between the potential benefits of acid-suppressant drugs or corticosteroids and the increased risk of infection in patients at high risk for post-stroke infection.

Three-dimensional Volume Changes of the Reconstructed Breast Following DIEP Flap Breast Reconstruction.

BACKGROUND: This study aimed to assess whether the reconstructed breast volume changed postoperatively following a deep inferior epigastric artery perforator (DIEP) flap. METHODS: Patients were included if they had undergone unilateral breast reconstruction with a DIEP flap at the two selected centers between April 2017 and September 2019. Serial 3-D surface imaging of both breasts was taken at 1, 3, 6, and 12 months postoperatively. The primary outcome was a volume ratio of the reconstructed to the contralateral breast. A linear mixed-effect model was used to evaluate whether the DIEP flap volume changed according to the postoperative time. RESULTS: A total of 74 patients were included in the analysis. The mean volume ratio of the reconstructed side compared with the contralateral breast at 1, 3, 6, and 12 months postoperatively were 106.9%, 105.9%, 108.7%, and 107.6%, respectively. In the linear mixed effect model, the volume ratio of the reconstructed breast did not change over time for immediate reconstructions (p = 0.376). However, there was an increase over time in delayed reconstructions (p = 0.043). Adjuvant radiation, chemotherapy, and hormone therapy did not influence the volume ratio of the reconstruced breast. Correlation analysis using repeatedly measured values showed that both reconstruced and healthy breast volumes had positive correlation with the patient's body weight (p < 0.001). On the other hand, volume ratio of the breasts was not influenced by the patient's body weight (p = 0.493). The volume ratio of the reconstructed breast significantly decreased in the upper inner (p = 0.003) and the upper outer (p = 0.006) quadrants, while increasing in the lower outer (p = 0.002) quadrant throughout the first-year postoperative period. CONCLUSION: The volume ratio of the reconstructed to the contralateral breast does not decrease postoperatively following DIEP flap breast reconstruction.

Real-Time Interactive Digital Health Care System for Postoperative Breast Cancer Patients: A Randomized Controlled Trial.

Introduction: Limited range of motion (ROM) of the shoulder occurs commonly after breast cancer surgery, resulting in reduced quality of life and difficulty with activities of daily living. Physical exercise is effective in postoperative breast cancer patients, but no study has assessed the effects of augmented reality (AR)-based telerehabilitation. Therefore, this study aimed to investigate the effect of hospital-home linked rehabilitation therapy using an AR-based digital health care system (UINCARE Home+) in postoperative patients with breast cancer. Methods: This study was a prospective, multicenter, assessor-blinded, randomized controlled trial. Patients who underwent breast cancer surgery were assigned to either the UINCARE Home+ (intervention) group or the brochure-based home rehabilitation (control) group for an 8-week intervention. The study outcomes were the change in ROM of the affected shoulder, pain in the affected shoulder (Numerical Rating Scale [NRS]), functional outcomes (Disabilities of the Arm, Shoulder, and Hand questionnaire [QuickDASH] score), and quality of life (Functional Assessment of Cancer Therapy-Breast [FACT-B] and EuroQoL 5-Dimension 5-Level [EQ-5D-5L] scores), all of which were measured at enrollment and at 4, 8, and 12 weeks thereafter. Results: A total of 100 participants were enrolled in the study (n = 50 in each groups). In both groups, active and passive ROM, NRS, and the QuickDASH, FACT-B, and EQ-5D-5L scores showed significant improvements from baseline to 12 weeks (p < 0.001), but no group differences were detected. Discussion: A home-based exercise program with an AR system improved shoulder dysfunction in breast cancer patients and could be used in conjunction with a traditional hospital-based rehabilitation program. Trial Registration: ClinicalTrials.gov ID: NCT04316156.

The effect of breast cancer surgery on spine alignment: Whole-spine radiograph analysis.

Breast cancer survivors may experience spinal deformity following breast cancer surgery. This study investigated the long-term effects of breast cancer surgery on whole-spine alignment. This retrospective study included 200 patients who underwent breast cancer surgery and ≥2 anteroposterior standing whole-spine X-rays. The curvature of the spine was measured using the Cobb angle; changes in Cobb angle between X-rays were compared among three groups according to breast cancer surgery type. The mean interval between initial and follow-up X-ray was 28.46 ± 13.39 months. The change in Cobb angle was 0.40 ± 1.65 degrees and the absolute value of that change was 1.25 ± 1.15 degrees in all patients with breast cancer. There were no significant differences in angular change among groups according to breast cancer surgery type. Most patients showed minimal changes in spinal alignment after breast cancer surgery. Our findings indicate that breast cancer surgery does not negatively affect spinal alignment.

Bioimpedance phase angle and sarcopenia in older patients with prostate cancer.

AIM: The purpose of this study was to evaluate the factors associated with the bioimpedance phase angle (PhA) in older patients with prostate cancer, and to determine the optimal cutoff for the PhA in patients with sarcopenia and prostate cancer. METHODS: This retrospective cross-sectional analysis enrolled patients with prostate cancer aged ≥60 years. Appendicular skeletal muscle mass and PhA estimated by bioimpedance analysis, grip strength, the five-time chair stand test, gait speed, the Short Physical Performance Battery, the 2-min walk test and the International Physical Activity Questionnaire Short Form were obtained at enrollment. The diagnosis of sarcopenia was based on the 2019 consensus of the Asian Working Group for Sarcopenia. RESULTS: In total, 119 male participants (mean age = 70.7 ± 6.1 years) were available for analysis. A multivariable linear regression model revealed that age, body mass index and the maximal grip strength value were associated with the PhA. The area under the receiver operating characteristic curve value of the PhA for sarcopenia diagnosis was 0.77 (95% confidence interval 0.64-0.90, P < 0.001), with a PhA cutoff value of 4.87°. CONCLUSIONS: PhA estimated by bioimpedance analysis may be utilized as useful clinical biomarker for reflecting muscle strength and sarcopenia in older patients with prostate cancer. Geriatr Gerontol Int 2022; 22: 623-627.

Reconstruction of congenital microtia after ear canaloplasty using V-Y advancement of a temporal triangular flap.

BACKGROUND: Reconstruction of congenital microtia remains challenging, particularly in patients with a history of ear canaloplasty due to insufficient regional soft tissue. The insertion of a tissue expander prior to implantation of the cartilage framework has traditionally been employed. However, this procedure could induce additional morbidity. Herein, we present a method using V-Y advancement of a temporal triangular flap to gain additional soft tissue in these challenging cases. METHODS: Congenital microtia patients with a history of ear canaloplasty who underwent auricular reconstruction using the Nagata technique between 2016 and 2020 were reviewed. To obtain additional soft tissue, V-Y advancement of a temporal triangular flap was performed concurrently with implantation of the costal cartilage framework, without prior insertion of a tissue expander. The outcomes of these patients with respect to postoperative complications and esthetics were evaluated. RESULTS: Eight patients with bilateral lesions were included. No specific complications developed after the first-stage surgery. However, one patient experienced complications after the second stage (auricular elevation). An analysis of the esthetic results showed most patients had excellent outcomes, achieving a satisfactory convolution. The median number of operations needed to complete reconstruction was 2, which was fewer than required using the conventional method with prior insertion of a tissue expander. CONCLUSIONS: In patients with a history of previous canaloplasty, V-Y advancement of a temporal triangular flap could serve as an alternative to tissue expansion for microtia reconstruction. This technique provided reliable and satisfactory results with a reduced number of surgical stages.

Real-time interactive digital healthcare system for post-operative breast cancer patients: study protocol for a randomized controlled trial.

BACKGROUND: After receiving breast cancer surgery or reconstruction, shoulder dysfunctions including weakness, post-operative pain, shoulder joint instability, and limited range of motion (ROM) often occur. Due to limited ROM, patients may suffer difficulty in activities of daily living, and quality of life may be reduced. The objective of this study is to compare the effects on shoulder ROM of a real-time interactive digital healthcare system and brochure-based home rehabilitation program in post-operative breast cancer patients. METHODS: This study is a prospective, multi-center, assessor-blinded randomized controlled trial. The study aims to recruit 100 breast cancer patients exhibiting limited shoulder ROM after undergoing axillary lymph node dissection or breast reconstruction following mastectomy. Patients will be randomly assigned to two groups for 8 weeks of rehabilitation: a digital healthcare system rehabilitation (intervention) group and a brochure-based rehabilitation (control) group. The primary outcome is the change in ROM of the affected shoulder between baseline and 12 weeks after enrollment. Secondary outcomes include pain in the affected shoulder, as measured using a numerical rating scale, functional outcomes (QuickDASH scores), and quality of life (FACT-B and EQ-5D-5L scores), all of which will be measured on enrollment and 4, 8, and 12 weeks thereafter. DISCUSSION: This study will compare the effectiveness of a newly developed, augmented reality-based real-time interactive digital healthcare system with that of brochure-based home rehabilitation for improving the shoulder ROM, pain, functional outcomes, and quality of life of post-operative breast cancer patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04316156 . Registered on 20 March 2020.

Effects of antihypertensive drugs on surgical outcomes of breast reconstruction: a nationwide population-based claim study.

BACKGROUND: Experimental studies have reported that angiotensin receptor blockers (ARBs) increase the risk of surgical complications. However, clinical data on their effect on surgical outcomes are limited. The aim of this study was to investigate the impact of perioperative use of ARBs on the outcomes of breast reconstruction using population-based claim data. METHODS: Data of patients who underwent direct-to-implant or abdomen-based autologous breast reconstruction after total mastectomy from April 2015 to December 2018 were obtained from the Health Insurance Review and Assessment Service database. The patients were categorized as ARB, non-ARB, control, and non-hypertension groups. The effects of ARBs on surgical complications, length of hospital stay, and complication-related medical costs were evaluated. RESULTS: Of the 9,036 patients who met the inclusion criteria, 5,192 underwent direct-to-implant reconstruction, and 3,844 underwent abdomen-based autologous reconstruction. The length of hospital stay was the longest and the surgical complication rate and complication-related medical cost were the highest in the ARB group after both reconstruction methods. Compared with non-treatment with antihypertensive drugs, ARB use was found to be an independent risk factor for surgical complications in direct-to-implant reconstruction [odds ratio (OR), 1.96; 95% confidence interval (CI), 1.09-3.50; P=0.0237] and complication-related medical cost (OR, 1.93; 95% CI, 1.10-3.40; P=0.0221) in abdomen-based autologous reconstruction. CONCLUSIONS: Perioperative ARB use was associated with adverse postoperative breast reconstruction outcomes. These findings might have a significant impact on perioperative antihypertensive management; nevertheless, further studies are warranted to confirm the study findings.

Does the Textured-Type Tissue Expander Affect the Outcomes of Two-Stage Prosthetic Breast Reconstruction? A Propensity Score Matching Analysis between Macrotextured and Microtextured Expanders.

BACKGROUND: In two-stage prosthetic breast reconstruction, two types of tissue expanders are used for the first stage: microtextured Siltex and macrotextured Biocell. Despite emerging concerns regarding the safety of macrotextured prostheses, the association between the use of macrotextured expanders and adverse outcomes remains unknown clinically. This study aimed to evaluate potential impacts of the type of tissue expander on the long-term outcomes of implant-based breast reconstruction. METHODS: Patients who underwent immediate two-stage tissue expander/implant breast reconstruction between 2014 and 2018 were evaluated and categorized into two groups according to the expander type. Those two were propensity score matched for baseline characteristics and compared for complication rates after the first- and second-stage operations. The impacts of several variables, including type of tissue expander used, on outcomes were assessed using multivariable logistic regression analyses. RESULTS: Of the 1391 cases in 1294 patients, 276 pairs (552 cases) were successfully propensity score matched. In the first-stage operation, the macrotextured group showed a significantly shorter drain indwelling period and lower rate of seroma than the microtextured group. These differences retained influences after adjusting for other variables. Incidence rates of other complications were similar between the groups. Regarding the second-stage operation, the use of macrotextured expanders showed a significant association, with an increased rate of severe capsular contracture on the multivariable analyses in cases using textured implants. Development of other complications was not affected by the expander type. CONCLUSION: The type of tissue expander might influence the outcomes of two-stage implant-based breast reconstruction, and generally acceptable safety of both microtextured and macrotextured expanders was shown. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Risk Factors for Delayed Resorption of Costal Cartilage Framework Following Microtia Reconstruction.

Background: Resorption of the cartilage framework results from hematoma or infection, deteriorating outcomes in microtia reconstruction. Delayed resorption still occurs for unclear reasons in patients without adverse events. The risk factors for delayed framework resorption were explored in this 20-year microtia cohort. Methods: Patients who underwent auricular elevation >5 years ago were reviewed from January 2001 to March 2019. Bilateral microtia, infection, and hematoma cases were excluded. Framework resorption was graded on the last photographs as none to minimal (grade 1), blunted but all components present (grade 2), loss of either the helical or antihelical component (grade 3), and loss of all components (grade 4). Logistic regression was used to evaluate independent risk factors for grade 3 and 4 resorption. Results: Of the 367 patients, 132 revisited our institution with a mean postoperative duration of 8.0 years. Grade 1 resorption was seen in 37.1%, 2 in 31.8%, 3 in 24.2%, and 4 in 6.8%. Canalplasty increased the risk of resorption regardless of timing (before auricular elevation, p = 0.017; after auricular elevation, p = 0.011). Body mass index at the time of cartilage harvest lowered the risk of resorption (p = 0.057) with clinical significance. Conclusions: Canalplasty may be avoided given the risk of framework resorption or may be performed with antiresorption strategies if the expected hearing outcome is superior. Our timing of harvest at the age of 10 years may have ensured cartilage maturation, both in terms of size and biomechanics, resulting in the resistance to resorption.

Multi-dimensional bioinspired tactics using an engineered mussel protein glue-based nanofiber conduit for accelerated functional nerve regeneration.

Limited regenerative capacity of the nervous system makes treating traumatic nerve injuries with conventional polymer-based nerve grafting a challenging task. Consequently, utilizing natural polymers and biomimetic topologies became obvious strategies for nerve conduit designs. As a bioinspired natural polymer from a marine organism, mussel adhesive proteins (MAPs) fused with biofunctional peptides from extracellular matrix (ECM) were engineered for accelerated nerve regeneration by enhancing cell adhesion, proliferation, neural differentiation, and neurite formation. To physically promote contact guidance of neural and Schwann cells and to achieve guided nerve regeneration, MAP was fabricated into an electrospun aligned nanofiber conduit by introducing synthetic polymer poly(lactic-co-glycolic acid) (PLGA) to control solubility and mechanical property. In vitro and in vivo experiments demonstrated that the multi-dimensional tactics of combining adhesiveness from MAP, integrin-mediated interaction from ECM peptides (in particular, IKVAV derived from laminin α1 chain), and contact guidance from aligned nanofibers synergistically accelerated functional nerve regeneration. Thus, MAP-based multi-dimensional approach provides new opportunities for neural regenerative applications including nerve grafting. STATEMENT OF SIGNIFICANCE: Findings in neural regeneration indicate that a bioinspired polymer-based nerve conduit design should harmoniously constitute various factors, such as biocompatibility, neurotrophic molecule, biodegradability, and contact guidance. Here, we engineered three fusion proteins of mussel-derived adhesive protein with ECM-derived biofunctional peptides to simultaneously provide biocompatibility and integrin-based interactions. In addition, a fabrication of robust aligned nanofiber conduits containing the fusion proteins realized suitable biodegradability and contact guidance. Thus, our multi-dimensional strategy on conduit design provided outstanding biocompatibility, biodegradability, integrin-interaction, and contact guidance to achieve an accelerated functional nerve regeneration. We believe that our bioengineered mussel adhesive protein-based multi-dimensional strategy would offer new insights into the design of nerve tissue engineering biomaterials.