Hand muscle synergy in chopstick use: effect of object size and weight.

This study explains the role of muscle coordination in chopstick manipulation and investigates the effects of object width and weight on intrinsic and extrinsic hand muscle activity when picking up objects with chopsticks. Surface electromyography was used to measure the activity of the intrinsic and extrinsic hand muscles when picking up objects of varying widths and weights using chopsticks. The results revealed coordinated muscle activity patterns in the intrinsic and extrinsic hand muscles and coordination between them during chopstick manipulation. Object widths varying between 1 and 3 cm did not significantly affect muscle activity; however, object weight influenced muscle activity during both chopstick closing and object grasping, with greater muscle activity in the 40 g condition than in the 10 g condition. Intrinsic hand muscles were found to be involved in object grasping, regardless of object weight. These findings suggest that object weight should be considered when practicing picking up objects with chopsticks in scenarios resembling daily dining, to prevent excessive muscle activity during rehabilitation.

A randomized controlled trial of changes in resting-state functional connectivity associated with short-term motor learning of chopstick use with the non-dominant hand.

INTRODUCTION: This study identified the offline brain networks associated with motor learning of non-dominant hand chopstick use within-session. METHODS: 40 healthy right-handed adults were randomly assigned to the practice and control groups (20 each). The performance, resting-state functional connectivity (RSFC), and their correlation were compared within and between groups. Both groups repeated 9 cycles of 30 s task and rest. During the task, the practice group performed the chopstick-use practice with their left hand, while the control group held chopsticks without acquiring any skills. During the rest, both groups fixated their gaze on a fixation point. The number of times candies were moved using chopsticks with the left hand in 30 s was used to evaluate the performance. RSFC was obtained by resting-state fMRI scanning and extracting Z-scores between the right primary motor cortex and all other brain regions. RESULTS: Both the groups improved in the post-task performance; the practice group improved more. The RSFC of the two networks increased in the practice group. One network was the RSFC between the right M1 and the right cerebellar Crus I, positively correlated with performance in the post-task. Another was the RSFC between the right M1 and the left cerebellar Crus II, positively correlated with skills in the amount of change pre- and post-task. CONCLUSION: Offline enhancement of RSFC in these networks was shown to contribute to early chopstick-use motor learning with the left hand. These results serve as a basis for future studies on compensatory networks in individuals with stroke.

Microscopic and endoscopic "chopstick" technique removal of choroid plexus papilloma in the third ventricle of an infant: a case report with systematic review of literature.

Background: Choroid plexus papilloma (CPP) is rare and even rarer in infants and young children, and it usually occurs in the ventricles. Due to the physical peculiarities of infants, tumor removal by microscopic or endoscopic surgery alone is difficult. Case Presentation: A 3-month-old patient was found to have an abnormally enlarged head circumference for 7 days. Cranial magnetic resonance imaging (MRI) examination revealed a lesion in the third ventricle. The patient underwent combined microscopic and endoscopic "chopstick" technique to remove the tumor. He recovered well after the surgery. Postoperative pathological examination revealed CPP. Postoperative MRI suggested total resection of the tumor. Follow-up for 1 month showed no recurrence or distant metastasis. Conclusions: Combined microscopic and endoscopic "chopstick" technique may be a suitable approach to remove tumors in infant ventricles.

Learning curve for laparoendoscopic single-site radical hysterectomy using the "chopstick" technique: a retrospective cohort study.

Background: Laparoendoscopic single-site surgery (LESS), as a promising minimally invasive surgery, is confronted with the obstacle of the "chopstick effect" which limits its further application. The "chopstick" technique is characterized by the usage of instruments of parallel and equal length, and in operations relying on double-fulcrum and unique surgeon position can play a key role in overcoming the above disadvantage effect. This study sought to explore the learning curve for the use of the novel "chopstick" technique in laparoendoscopic single-site radical hysterectomy (LESS-RH) and evaluate the technique's practicability. Methods: Consecutive cervical cancer patients who underwent LESS-RH with the "chopstick" technique by a surgeon with rich experience in laparoscopy from November 2016 to September 2018 were included in the study. The learning curve of his surgeries with the "chopstick" technique was evaluated using the cumulative summation (CUSUM) method by analyzing operation time (OT) which was the surrogate indicator of surgical ability. The patients were divided into Phase I and Phase II based on the learning curve peak, whose demographic and perioperative characteristics, such as tumor Federation International of Gynecology and Obstetrics (FIGO) stage and histology, operation time, blood loss, and complications were collected and analyzed. Results: The mean OT was 231.5 min (range, 115-355 min). The division of the learning curve based on OT occurred after the first 15 cases were finished, dividing Phase I and Phase II. The mean OT for Phase I (259 min) was significantly longer than that of Phase II (219 min) (P=0.02). Only 1 intraoperative complication occurred in Phase I, and none occurred in Phase II. Major postoperative complications occurred more frequently in Phase I (N=3) than in Phase II (N=0). No significant differences were observed in terms of lymph nodes, blood loss, or pathological features. Conclusions: The "chopstick" technique may help surgeons obtain stable LESS surgical performance through a relatively short learning curve, even in some complex surgeries, such as radical hysterectomy.

Chopstick technique versus cross technique in LESS hysterectomy (CCLEH study): a prospective randomized controlled trial.

BACKGROUND: The traditional cross technique can be used to complete most laparoendoscopic single-site surgery (LESS) procedures, but some relatively precise operations, such as vaginal stump suturing, are challenging. In practice, we have introduced a novel technique named the chopstick technique and applied it to more complex operations, such as cervical cancer operations, and found that it contributes to performing delicate surgery. The efficacy and safety of two different surgical techniques in LESS hysterectomy remain to be validated. METHODS: Patients who undergo total hysterectomy will be enrolled in this RCT. Stratified randomization will be performed according to uterine size (< 10 cm, 10-15cm, ≥ 15 cm). The participants will be divided into the chopstick technique group or cross technique group to undergo laparoendoscopic single-site total hysterectomy (LESS-TH), and then the perioperative and postoperative data, including the total operation time and other times, transfer rates, estimated blood loss, surgeon fatigue, intraoperative and postoperative complications (within 8 weeks after surgery), health-related quality of life (EQ-5D) scores, postoperative hospital stay, and hospitalization expenses, will be evaluated. The primary outcome is the operating time for total hysterectomy under LESS, and the other outcomes are secondary outcomes. DISCUSSION: It is expected that the efficacy of the two techniques in LESS, the chopstick technique vs. the cross technique, will be compared and accumulate safety data on the new techniques will be accumulated. TRIAL REGISTRATION: ChiCTR2000040843, registered on June 16,2020 Protocol version: Version 2.0; Date: 2020.05.10.

A case of death of purulent meningitis caused by transorbital intracranial penetrating injury due to long-term residual bamboo chopstick.

This article reports a case of death caused by purulent meningitis after a long-term transorbital intracranial penetrating injury induced by a bamboo chopstick. A 53-year-old man was pierced with a bamboo chopstick into the left orbit, and the bamboo chopstick broke off. The man remained conscious after the injury but developed paroxysmal headaches. Multiple computed tomography, computed tomography angiography, and rhinoscopy detections revealed that a puncture tract had formed from the left orbit to the right edge of the brainstem through the skull base. However, there was no apparent brain injury or cerebrovascular rupture, thus excluding the possibility of a retained intracranial foreign body by the neurosurgeon. Therefore, the man only received symptomatic and conservative treatments. Unfortunately, the man was found dead one morning, 13 months later. Autopsy and histopathological examinations revealed that he died of purulent meningitis caused by a long-term residual intracranial bamboo chopstick. A review of the relevant literature regarding the diagnosis, including diagnostic values and limitations of different imaging technologies, and treatment of residual intracranial foreign bodies, revealed that this was a case of misdiagnosis, leading to delayed treatment. This case had an indirect causal relationship between the victim's death and medical treatment. This article provides clinical strategies for diagnosing and treating such cases and a forensic perspective for identifying causes of deaths attributed to medical malpractices.

Outcomes of Laparoscopic Common Bile Duct Exploration by Chopstick Technique in Choledocholithiasis.

BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy with common bile duct exploration (LC with LCBDE) remains the preferred technique for difficult common bile duct stone (CBDS) removal. The chopstick method uses commonly available instruments and may be cost-saving compared to other techniques. We studied the outcome of LCBDE using the chopstick technique to determine if it could be considered a first-choice method. METHODS: Data from all patients that underwent LCBDE from January 1, 2012 to April 30, 2019 were retrospectively analyzed. A standard 4-port incision and CBDS permitted extraction with two laparoscopic instruments by chopstick technique via vertical choledochotomy. Demographic data, stone clearance rate, surgical outcomes, complications, and other associated factors were evaluated. RESULTS: Thirty-two patients underwent LCBDE. The mean number of preoperative endoscopic retrograde cholangiopancreatography (ERCP) sessions was 2.4. In 65.5% of cases, the CBDS was completely removed by the chopstick technique, while 96.9% of stones were removed after using additional tools. The need for additional instruments was associated with increased age, increased numbers of stones, longer period from the latest ERCP session, and previous upper abdominal surgery. The conversion rate to open surgery was 28.1% and was significantly associated with a history of upper abdominal surgery. CONCLUSION: The chopstick technique is a good alternative and could be considered as a first-line technique in LCBDE to remove the CBDS in cases with 1 to 2 large suprapancreatic CBDS due to instrument availability, cost-effectiveness, and comparable surgical outcomes.

An Open-Source Add-On EVOM® Device for Real-Time Transepithelial/Endothelial Electrical Resistance Measurements in Multiple Transwell Samples.

This study provides design of a low-cost and open source add-on device that enhances the functionality of the popular EVOM® instrument for transepithelial/endothelial electrical resistance (TEER) measurement. The original EVOM® instrument is designed for measuring TEER in transwell samples manually using a pair of Ag/AgCl electrodes. The inconsistency in electrode placement, temperature variation, and a typically large (12-24 h) time interval between measurements result in large data variabilities. Thus, to solve the current limitation of the EVOM® instrument, we built an add-on device using a custom designed electronic board and a 3D printed electrode holder that allowed automated TEER measurements in multiple transwell samples. To demonstrate the functionality of the device prototype, we monitored TEER in 4 transwell samples containing retinal cells (ARPE-19) for 67 h. Furthermore, by monitoring temperature of the cell culture medium, we were able to detect fluctuations in TEER due to temperature change after the medium change process, and were able to correct the data offset. Although we demonstrated the use of our add-on device on EVOM® instrument only, the concept (multiplexing using digitally controlled relays) and hardware (custom data logger) presented here can be applied to more advanced TEER instruments to improve the performance of those devices.

Microsurgical confirmation of parenchymal contamination of hair in a pediatric patient with a penetrating head injury.

Penetrating head injuries are rare, but can cause severe morbidity in children. In particular, penetrating head trauma with a wooden foreign body is considered to be likely to cause central nervous system infections because of its porosity and softness. However, actually confirming minute contaminations, such as skin debris or hair, in the brain parenchyma is rare. We report the case of a 2-year-old boy who presented with a penetrating head injury by a chopstick. During surgical removal of the chopstick, intraparenchymal hair contamination was confirmed under a surgical microscope. The postoperative course of the patient was uneventful. After 13 months of follow-up without any infectious events, the patient remains well and asymptomatic. The findings in the present case demonstrate that in the case of a penetrating head trauma with a wooden foreign body, surgical removal and active debridement should be the treatment of first choice.

Case Report: Transoral Penetrating Medullocervical Injury by a Chopstick in Three Cats.

This case series describes transoral penetrating or contusive medullocervical injury by a wooden chopstick in three young cats presenting with acute tetraparesis. CT revealed that remnant fragments of a wooden chopstick penetrated the atlantooccipital space in cases 1 and 2. The remnant fragments were visualized clearly on CT under the bone window setting. MRI revealed a hyper-intense lesion in the spinal cord parenchyma at the level of C1 on T2-weighted images in case 3. Tetraparesis improved after surgical removal of the remnant fragment in case 2 and with supportive care in case 3.

Radiological findings of transorbital penetrating intracranial injury in a child.

In penetrating injuries, woods are known to be difficult to detect with radiological imaging studies, because the wood density are known to be extremely close to the value of air on CT. Adjustment of CT window and reconstruction of a 3D image from CT images allowed us to more accurately distinguish wood from air and to find the fragment of the wooden chopstick. It is particularly useful in transorbital penetrating injury.

Transoral Intracranial Injury via Middle Skull Base by a Blunt Chopstick in a Child.

BACKGROUND: Transoral penetrating injury from a blunt-tipped chopstick is unusual and should be promptly dealt with because it is associated with high morbidity and mortality. CASE DESCRIPTION: We report a case of a 2-year-old girl who sustained a transoral penetrating brain injury after falling onto a bamboo chopstick, which penetrated through the hard palate and eventually led to middle skull base fracture as well as temporal lobe laceration and contusion. The chopstick was successfully extracted via a transoral approach followed by administration of empirical antibiotics and anticonvulsants. The postoperative course was uneventful, and a 2-year follow-up evaluation revealed a favorable outcome. CONCLUSIONS: Preoperative and postoperative imaging and extensive monitoring of the patient's condition are mandatory for evaluation of possible development of complications. An optimal result can be obtained by a tailored management and treatment approach for each specific patient.

Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign.

Imaging plays an important role in the diagnosis, staging and prognosis of JNA. Certain radiological changes as seen on CECT were observed to be consistent in our case series. This study analysed preoperative and postoperative CECT of large series of JNA patients to evaluate the sites and pattern of spread of tumor. We evaluated the clinical significance of pterygoid wedge in preoperative and postoperative imaging and thus elucidating two new radiological signs. Retrospective analysis of the pre operative and post operative imaging data of 242 patients with JNA. The findings in the scan were clinically correlated with the endoscopic intraoperative findings. Preoperative evaluation of the pterygoid wedge revealed widening on the involved side in 99.1% of our cases which is 1.8 times greater compared to the uninvolved side. The possibility of residual/recurrent tumor was found to be significantly higher in those where the pterygoid wedge was not removed by drilling (p < 0.001) Drilling of the pterygoid wedge intra operatively, reduced the rate of residual/recurrence from 31.9 to 3.07%. Widening of the pterygoid wedge seen in the preoperative CECT, referred as RAM HARAN sign occurs in JNA. It has a significant diagnostic value as a radiological sign in JNA. Drilling of the pterygoid wedge intraoperatively reduces the rate of recurrence of JNA. Appearance of the two pterygoid plates on postoperative CECT, as two parallel lines, referred as Chopstick sign, has a remarkable prognostic value as a radiological sign in JNA.

Orbitocranial Low-Velocity Penetrating Injury: A Personal Experience, Case Series, Review of the literature, and Proposed Management Plan.

BACKGROUND: Orbitocranial penetrating injuries (OPI) are an unfamiliar subset of head injury and are particularly rare in clinical practice. They are usually the result of falls or motor vehicle collisions and occur more commonly in children, who are prone to trauma while playing games improperly. METHODS: We present a retrospective review of 5 cases of OPI treated in the Neurotrauma Department at Xiangya Hospital of Central South University in the last 5 years. Also, we performed comprehensive literature searches using Web of Science and the terms "orbitocranial injury," "penetrating ocular trauma," "penetrating orbital trauma," and "transorbital chopstick penetrating injury" to search for presentation, mechanism of injury, and management of transorbital penetrating injury. RESULTS: In 2 patients, there was right internal carotid artery occlusion while in other 2 patients, the penetrating objects reached the brainstem through the cavernous sinus, resulting in orbital apex syndrome. All patients underwent a thorough physical examination followed by diagnostic imaging. The cases were successfully managed surgically by removing the foreign bodies through their trajectories. CONCLUSIONS: Computed tomography, magnetic resonance imaging, and computed tomography angiography are key imaging modalities that are frequently used to determine the course of the foreign object and the extent of brain tissue injury as well as to rule out vascular injury in these types of cases. Early surgical exploration by a multidisciplinary team approach is essential to attain good recovery and a favorable outcome.

Endoscopic retrieval of an 18-cm long chopstick embedded for ten months post-automutilation in the esophagus of a patient with psychosis.

Foreign body ingestion is an emergency or acute situation that commonly occurs in children or adults and involves the ingestion of one or more objects. Moreover, once the discovery of swallowed foreign bodies has been made, families are typically very anxious to have the patient see a doctor. If the foreign object becomes embedded in the digestive tract, it must be removed; in emergencies, this is done by endoscopy or surgery. This case report presents the successful endoscopic retrieval of a chopstick with both sides embedded 4 cm into the esophageal wall for > 10 mo in a male patient following automutilation in an attempt to be released from a psychiatric hospital. Hot hemostatic forceps were used to open the distal esophageal mucosa in which the chopstick was embedded. The procedure was performed under intravenous general anesthesia and took approximately 7 h.

Chopstick injury penetrating the skull base: a case report.

We describe an unusual case of a foreign body penetrating the skull base and lodging in the posterior fossa. A 38-year-old woman fell onto a chopstick while eating, causing it to impact into her mouth. The chopstick penetrated the oropharynx and the occipital bone via the jugular foramen to enter the posterior fossa intracranially, piercing the tentorium cerebelli and leaving a fractured tip in the occipital lobe. Three-dimensional reconstructive computed tomographic scans were obtained to view the trajectory and position of the chopstick. Reconstructed angiography revealed the proximity of the carotid artery and the jugular vessels to the foreign object. Safe access to the chopstick was via an occipital craniotomy to retrieve the distal portion and an ipsiplateral retrosigmoid craniectomy to remove the proximal end. Provision was made to gain proximal control of all major nearby vessels in the event of any hemorrhage. Trauma causing penetration of a foreign body into the posterior fossa of the skull is rare due to its surrounding thick bone. Appropriate preoperative planning, including 3-D computed tomographic images and angiograms, are integral in the surgical approach for the safe removal of such objects.

Homicidal Transorbital Intracranial Injury by a Metallic Chopstick: a Case Report / 대한법의학회지

The transorbital intracranial injury is a rare penetrating brain injury and few homicidal cases were reported. We report a case of 37 year-old man who died from a homicidal transorbital intracranial injury. The assailant was one of his friends, who pierced his left eye by a metallic chopstick. Despite the intensive care, he died one week after. Postmortem examination revealed only a small laceration with subcutaneous hematoma in left lower eyelid, fractures of medial orbital roof, body of sphenoid bone and sella turcica, diffuse cerebral edema, basal subarachnoid hematoma, focal subdural hematoma, and intraventricular hematoma in the right lateral ventricle.