RPNI, TMR, and Reset Neurectomy/Relocation Nerve Grafting after Nerve Transection in Headache Surgery.

In the context of headache surgery, greater occipital nerve (GON) transection is performed when the nerve appears severely damaged, if symptoms are recurrent or persistent, and when neuromas are excised. Lesser occipital nerve (LON) excision is commonly performed during the primary decompression surgery. Advanced techniques to address the proximal nerve stump after nerve transection such as regenerative peripheral nerve interface (RPNI), targeted muscle reinnervation (TMR), relocation nerve grafting, and reset neurectomy have been shown to improve chronic pain and neuroma formation. These techniques have not been described in the head and neck region. Methods: This article describes RPNI, TMR, and reset neurectomy with GON autograft relocation to prevent chronic pain and neuroma formation after GON/LON transection. Results: RPNI and TMR are feasible options in patients undergoing GON/LON transection. Further, relocation nerve grafting with GON autograft relocation is a method that is beneficial in patients with diffuse nerve injury requiring proximal nerve division. Conclusion: Advanced nerve reconstruction techniques should be considered in headache surgery following GON/LON transection.

Correlation of bioimpedance changes after compressive loading of murine tissues in vivo.

OBJECTIVE: Rises in the incidence of pressure ulcers are increasingly prevalent in an aging population. Pressure ulcers are painful, are associated with increased morbidity and mortality, increase the risk for secondary infections and inpatient stay, and adds $26.8 billion annually to the healthcare costs of the USA. Evidence suggests that a change in the bioimpedance of living tissue in response to continuous local contact pressure can be a useful indicator for the onset of pressure injuries. APPROACH: Thirty-five Sprague Dawley rats were subjected to various skin pressures for differing periods of time via a surgically inserted steel disk and an externally applied magnet. Contact pressure and bioimpedance were measured and correlated with tissue loading intensity and compared to clinical ulcer grading. MAIN RESULTS: Moderate relationships between bioimpedance changes and tissue loading intensity were found. Stronger correlations were found by utilizing a combination of bioimpedance and phase angle. Thresholds were applied to the bioimpedance parameters and the usefulness of bioimpedance in classifying different ulcer stages is demonstrated. SIGNIFICANCE: These results indicate that bioimpedance may be useful as an early indicator of pressure ulcer formation and has practical significance in the development of early pressure injury detection devices.

Hepatic Epithelioid Angiomyolipoma Treated with Laparoscopic Resection: Case Report and Review of the Literature.

Hepatic angiomyolipoma is a rare primary liver tumor, with a radiographic appearance very similar to hepatocellular carcinoma. We present the case of a noncirrhotic patient with a liver tumor suspicious for HCC by imaging features. Liver biopsy demonstrated angiomyolipoma, and the patient successfully underwent a laparoscopic liver resection.

Wireless Pressure Ulcer Sensor: Validation in an Animal Model.

Pressure ulcers are increasingly prevalent in an aging population. The most commonly used method of pressure ulcer prevention is pressure off-loading achieved by physically turning bedbound patients or by using expensive, single application devices such as wheelchair cushions. Our aim is to approach the problem of pressure ulcer prevention in a new way: a wireless sensor worn by the patient at locations susceptible to pressure injury. The sensor will monitor local pressure over time and transmits the data wirelessly to a base station (in a hospital setting) or smartphone (for home care). When a condition that would be harmful to tissue is reached, an alert would enable immediate direct intervention to prevent development of a pressure ulcer. The goal of this study was to validate the sensor's use in a live animal model and to lay the foundation for building time-pressure curves to predict the probability of pressure injury. Sprague-Dawley rats underwent surgical implantation of bilateral steel discs deep to the latissimus dorsi muscles. After the animals recovered from the surgical procedure, pressure was applied to the overlying tissue using magnets of varying strengths (30-150 mm Hg) for between 1 and 8 hours. Our sensor was placed on the skin prior to magnet application to wirelessly collect data regarding pressure and time. Three days after pressure application, animals were killed, injuries were graded clinically, and biopsies were collected for histological analysis. Results reveal that all animals with magnet application for more than 2 hours had clinical evidence of ulceration. Similarly, histological findings of hemorrhage were associated with increased time of pressure application. However, at high pressures (120-150 mm Hg), there were ischemic changes within the muscular layer without corresponding skin ulceration. We have developed a wireless sensor that can be placed on any at-risk area of the body and has the potential to alert caregivers when patients are at risk of developing a pressure injury. Our sensor successfully transmitted pressure readings wirelessly in a live, mobile animal. Future studies will focus on safety and efficacy with human use and development of algorithms to predict the probability of pressure ulcer formation.

A New Vision for Preventing Pressure Ulcers: Wearable Wireless Devices Could Help Solve a Common-and Serious-Problem.

With an aging population, the incidence and prevalence of wound problems is on the rise. Bedsores (also known as pressure ulcers or decubitus ulcers) are painful, take months to heal, and, for many patients, never do, leading to other health problems. The condition has become so acute that treating bedsores is now a significant burden on the healthcare system. An estimated 2.5 million pressure ulcers are treated in U.S. hospitals each year, adding US$11 billion annually to health care costs.

Axillary vein thrombosis induced by an increasingly popular oscillating dumbbell exercise device: a case report.

A 53 year-old male presented with a one-day history of a swollen arm and dull, aching pain in the right upper extremity. The patient reported commencing exercising daily over the prior week with a modified, oscillating dumbbell; commonly referred to as a Shake Weight. Imaging revealed an occlusive thrombus in the right axillary, proximal brachial and basilic veins. The patient was treated with a 24-hour tPA infusion followed by mechanical thrombectomy, balloon angioplasty, and stent placement for a residual thrombus and stenosis. The patient was discharged the following day on warfarin and aspirin. This is the first report of effort-induced thrombosis of the upper extremity following the use of a modified, oscillating dumbbell. Due to the growing popularity of modified dumbbells and the possible risk for axillary vein thrombosis, consideration should be made to caution consumers of this potential complication.

Migration of a fractured inferior vena cava filter strut to the right ventricle of the heart: a case report.

A 23 year old woman presented with sudden onset retrosternal chest pain following an attempt to move a heavy object from her vehicle. Multiple fractured struts of an inferior vena cava filter were identified in the distal right and left pulmonary artery branches, and in the free wall of the right ventricle. A small pericardial effusion was noted. Because of the depth of penetration into the right ventricle, it was perceived not to be amenable to endovascular retrieval. Over several days of observation, she continued to have progressive retrosternal and left shoulder pain. She underwent exploratory sternotomy and extraction of a strut that was partially protruding from the right ventricle and abrading the diaphragmatic pericardium. The patient recovered quite well and was discharged on the third postoperative day.

Kinetic studies on the reaction of chlorosulfonyl isocyanate with monofluoroalkenes: experimental evidence for both stepwise and concerted mechanisms and a pre-equilibrium complex on the reaction pathway.

Chlorosulfonyl isocyanate (CSI) is reported to react with hydrocarbon alkenes by a stepwise dipolar pathway to give N-chlorosulfonyl-ß-lactams that are readily reduced to ß-lactams. Substitution of a vinyl hydrogen for a vinyl fluorine changes the dynamics for reaction with CSI so that a concerted pathway is favored. Rate constants were measured for reactions of CSI with monofluoroalkenes and some hydrocarbon alkenes. Activation parameters for two hydrocarbon alkenes and two monofluoroalkenes support this change in mechanism. A plot generated from the natural log of rate constants vs ionization potentials (IP) indicates that fluoroalkenes with IP values >8.9 eV react by a concerted process. Electron-rich monofluoroalkenes with IP values <8.5 eV were found to react by a single-electron transfer (SET) pathway. Hydrocarbon alkenes were also found to react by this dipolar stepwise SET intermediate rather than the previously accepted stepwise dipolar pathway. Data support a pre-equilibrium complex on the reaction pathway just before the rate-determining step of the concerted pathway and a SET intermediate for the stepwise reactions. When the reactions are carried out at lower temperatures, the equilibrium shifts toward the complex or SET intermediate enhancing the synthetic utility of these reactions. Kinetic data also support formation of a planar transition state rather than the orthogonal geometry as reported for ketene [2 + 2] cycloadditions.

Reaction of chlorosulfonyl isocyanate with fluorosubstituted alkenes: evidence of a concerted pathway.

Concerted reactions are indicated for the electrophilic addition of chlorosulfonyl isocyanate with monofluoroalkenes. A vinyl fluorine atom on an alkene raises the energy of a stepwise transition state more than the energy of the competing concerted pathway. This energy shift induces CSI to react with monofluoroalkenes by a one-step process. The low reactivity of CSI with monofluoroalkenes, stereospecific reactions, the absence of 2:1 uracil products with neat fluoroalkenes, and quantum chemical calculations support a concerted pathway.