Phrenic to musculocutaneous nerve transfer for traumatic brachial plexus injuries: analyzing respiratory effects on elbow flexion control

OBJECTIVEIn this study, the authors sought to identify the relationship between breathing and elbow flexion in patients with a traumatic brachial plexus injury (TBPI) who undergo a phrenic nerve (PN) transfer to restore biceps flexion. More specifically, the authors studied whether biceps strength and the maximal range of active elbow flexion differ between full inspiration and expiration, and whether electromyography (EMG) activity in the biceps differs between forced maximum breathing during muscular rest, normal breathing during rest, and at maximal biceps contraction. All these variables were studied in a cohort with different intervals of follow-up, as the authors sought to determine if the relationship between breathing movements and elbow flexion changes over time.METHODSThe British Medical Research Council muscle-strength grading system and a dynamometer were used to measure biceps strength, which was measured 1) during a maximal inspiratory effort, 2) during respiratory repose, and 3) after a maximal expiratory effort. The maximum range of elbow flexion was measured 1) after maximal inspiration, 2) during normal breathing, and 3) after maximal expiration. Postoperative EMG testing was performed 1) during normal breathing with the arm at rest, 2) during sustained maximal inspiration with the arm at rest, and 3) during maximal voluntary biceps contraction. Within-group (paired) comparisons, and both correlation and regression analyses were performed.RESULTSTwenty-one patients fit the study inclusion criteria. The mean interval from trauma to surgery was 5.5 months, and the mean duration of follow-up 2.6 years (range 10 months to 9.6 years). Mean biceps strength was 0.21 after maximal expiration versus 0.29 after maximal inspiration, a difference of 0.08 (t = 4.97, p < 0.001). Similarly, there was almost a 21° difference in maximum elbow flexion, from 88.8° after expiration to 109.5° during maximal inspiration (t = 5.05, p < 0.001). Involuntary elbow flexion movement during breathing was present in 18/21 patients (86%) and averaged almost 20°. Measuring involuntary EMG activity in the biceps during rest and contraction, there were statistically significant direct correlations between readings taken during normal and deep breathing, which were moderate (r = 0.66, p < 0.001) and extremely strong (r = 0.94, p < 0.001), respectively. Involuntary activity also differed significantly between normal and deep breathing (2.14 vs 3.14, t = 4.58, p < 0.001). The degrees of involuntary flexion were significantly greater within the first 2.6 years of follow-up than later.CONCLUSIONSThese results suggest that the impact of breathing on elbow function is considerable after PN transfer for elbow function reconstruction following a TBPI, both clinically and electromyographically, but also that there may be some waning of this influence over time, perhaps secondary to brain plasticity. In the study cohort, this waning impacted elbow range of motion more than biceps muscle strength and EMG recordings.

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Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500358 ◽

2019 ◽

Vol 24 (03) ◽

pp. 283-288

Author(s):

Yusuke Nagano ◽

Daisuke Kawamura ◽

Alaa Terkawi ◽

Atsushi Urita ◽

Yuichiro Matsui ◽

...

Keyword(s):

Muscle Strength ◽

Brachial Plexus ◽

Ulnar Nerve ◽

Functional Outcomes ◽

Brachial Plexus Injury ◽

Nerve Transfer ◽

Elbow Flexion ◽

The Mean ◽

Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

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Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

Journal of Neurosurgery ◽

10.3171/2019.2.jns182620 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1914-1924 ◽

Cited By ~ 2

Author(s):

Liang Li ◽

Jiantao Yang ◽

Bengang Qin ◽

Honggang Wang ◽

Yi Yang ◽

...

Keyword(s):

Brachial Plexus ◽

Nerve Root ◽

Functional Outcomes ◽

Elbow Flexion ◽

Shoulder Abduction ◽

Allograft Reconstruction ◽

Acellular Nerve Allograft ◽

The Mean ◽

Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

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A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105144 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5144

Author(s):

Mar Muñoz-Chápuli Gutiérrez ◽

Ana Durán-Vila ◽

Javier Ruiz-Labarta ◽

Pilar Payá-Martínez ◽

Pilar Pintado Recarte ◽

...

Keyword(s):

Clinical Manifestations ◽

Specific Treatment ◽

Rt Pcr ◽

Good Adherence ◽

Major Morbidity ◽

Reference Hospital ◽

The Mean ◽

Discharge From Hospital ◽

Over Time

Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference hospital in Madrid. We included patients with RT-PCR-confirmed COVID-19 during pregnancy or delivery from 10 March 2020 to 15 December 2020. We had a total of 211 obstetric patients: 148 (70.1%) were tested at the onset of suspicious clinical manifestations and 62 (29.4%) were tested in the context of routine screening. Of all the patients, 60 women (28.4%) were asymptomatic and 97 (46%) presented mild symptoms. Fifty-one women (24.2%) were admitted to our hospital for specific treatment because of moderate or severe symptoms. We had no missed cases and a good adherence. The mean number of calls per patient was 2.3. We performed 55 in-person visits. We analyzed the complexity of our program over time, showing a two-wave-like pattern. One patient was identified as needing hospitalization and we did not record major morbidity. Telemedicine programs are a strong and reproducible tool to reach to pregnant population affected by COVID-19, to assess its symptoms and severity, and to record for pregnancy-related symptoms both in an outpatient regime and after discharge from hospital.

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Cycle length of nonsustanied ventricular tachycardias among ICD patients: implications on subsequent appropriate therapies

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02087-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Javier Jiménez-Candil ◽

Olga Duran ◽

Armando Oterino ◽

Jendri Pérez ◽

Juan Carlos Castro ◽

...

Keyword(s):

At Risk ◽

Secondary Prevention ◽

Beta Blocker ◽

Cycle Length ◽

Close Relationship ◽

Appropriate Therapy ◽

The Mean ◽

Ventricular Tachycardias ◽

The Relationship

Abstract Background ICD patients with episodes of nonsustained ventricular tachycardias (NSVT) are at risk of appropriate therapies. However, the relationship between the cycle length (CL) of such NSVTs and the subsequent incidence of appropriate interventions is unknown. Methods 416 ICD patients with LVEF < 45% were studied. ICD programming was standardized. NSVT was defined as any VT of 5 or more beats at ≥ 150 bpm occurred in the first 6 months after implantation that terminated spontaneously and was not preceded by any appropriate therapy. The mean follow-up was 41 ± 27 months. Results We analyzed 2201 NSVTs (mean CL = 323 ms) that occurred in 250 patients; 111 of such episodes were fast (CL ≤ 300 ms). Secondary prevention (HR = 1.7; p < 0.001), number of NSVT episodes (HR = 1.05; 95% CI 1.04–1.07; p < 0.001) and beta-blocker treatment (HR = 0.7; p = 0.04) were independent predictors of appropriate interventions; however, the mean CL of NSVTs was not (p = 0.6). There was a correlation between the mean CL of NSVTs and the CL of the first monomorphic VT: r = 0.88; p < 0.001. This correlation was especially robust in individuals with > 5 NSVTs (r = 0.97; p < 0.001), with an agreement between both values greater than 95%. Patients with any fast NSVT experienced a higher incidence of VF episodes (26%) compared to those without NVSTs (3%) or with only slow NSVTs (7%); p < 0.001. Conclusions Unlike the burden, the CL of NSVTs is not a predictor of subsequent appropriate interventions. However, there is a close relationship between the CL of NSVTs and that of arrhythmias that will later lead to appropriate therapies.

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Kidney function decline is associated with an accelerated increase in plasma homocysteine in older adults: a longitudinal study

British Journal Of Nutrition ◽

10.1017/s0007114521001690 ◽

2021 ◽

pp. 1-21

Author(s):

Hui Zhang ◽

Yi Li ◽

Meng Hao ◽

Xiaoyan Jiang ◽

Jiucun Wang ◽

...

Keyword(s):

Kidney Function ◽

Repeated Measurements ◽

Baseline Survey ◽

Mixed Effect ◽

Pronounced Increase ◽

Crude Model ◽

The Mean ◽

Kidney Function Decline ◽

Over Time

Abstract Background: Few studies have been conducted to investigate the association of kidney function decline with the trajectories of homocysteine (Hcy) over time, using repeated measurements. We aimed to investigate the association of kidney function with changes in plasma Hcy levels over time. Methods: Data were collected from the Rugao Longevity and Ageing Study. In detail, plasma Hcy and creatinine levels were measured in both waves (waves 2, 3 and 4) during the 3.5-year follow-up (N = 1135). Wave 2 was regarded as the baseline survey. The estimated glomerular filtration rate (eGFR) was calculated based on creatinine. Subjects were categorized into four groups according to quartiles of eGFR at baseline. Linear mixed-effect models were used to investigate the association of eGFR with subsequent plasma Hcy levels. Results: The mean eGFR at baseline was 90.84 (11.42) mL/min/1.73 m2. The mean plasma Hcy level was 14.09 (6.82) at baseline and increased to 16.28 (8.27) and 17.36 (10.39) μmol/L during follow-ups. In the crude model, the interaction between time and eGFR at baseline was significant (β = −0.02, 95% CI: −0.02 to −0.01, p = 0.002). After adjusting for confounding factors, a significant relationship remained (β = −0.02, 95% CI: −0.02 to −0.01, p = 0.003), suggesting that kidney function decline at baseline was associated with a faster increase in Hcy levels. Conclusion: Kidney function decline is associated with a more pronounced increase in plasma Hcy levels. Further studies with longer follow-up periods and larger sample sizes are needed to validate our findings.

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A Dyadic Perspective on Coping and its Effects on Relationship Quality and Psychological Distress in Couples Living with Chronic Pain: A Longitudinal Study

Pain Medicine ◽

10.1093/pm/pnz267 ◽

2019 ◽

Vol 21 (2) ◽

pp. e102-e113 ◽

Cited By ~ 2

Author(s):

Manasi M Mittinty ◽

Sara Kindt ◽

Murthy N Mittinty ◽

Sonia Bernardes ◽

Annmarie Cano ◽

...

Keyword(s):

Chronic Pain ◽

Relationship Quality ◽

Positive Association ◽

Psychological Outcomes ◽

Dyadic Coping ◽

Negatively Associated ◽

Curve Model ◽

The Relationship ◽

Over Time

Abstract Objective Dyadic coping is a process of coping within couples that is intended not only to support the patient with chronic pain but also to maintain equilibrium in the relationship. This study aims to investigate the effect of patient-perceived and spouse-reported dyadic coping on both the patient and their partner’s relationship quality and anxiety, stress, and depression over time. Methods One hundred thirty-nine couples, with one partner experiencing chronic pain, participated in this study. Spanning three measurements over six months, couples reported on their anxiety, stress, depression, relationship quality, and dyadic coping. Results Patient-perceived supportive dyadic coping was positively associated with both partners’ relationship quality but was negatively associated with spouses’ stress over time. Patient-perceived negative dyadic coping was negatively associated with both partners’ relationship quality and positively associated with patients’ depression and spouses’ depression and stress over time. Spouse-reported supportive dyadic coping showed a positive association with their own relationship quality and a negative association with spouses’ depression at baseline and patients’ depression at three-month follow-up. Spouse-reported negative dyadic coping was negatively associated with their relationship quality at baseline and positively associated with their partner’s anxiety and stress at six-month and three-month follow-up, respectively. Similar inference was observed from the findings of growth curve model. Conclusions As compared with spouse report, patient perception of dyadic coping is a better predictor of both partners’ relationship quality and psychological outcomes over time. Both partners may benefit from early psychosocial intervention to improve their dyadic coping, relationship quality, and psychological outcomes.

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Investigation of the Correlation between Postherpetic Itch and Neuropathic Pain over Time

Pain Research and Management ◽

10.1155/2018/9305126 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Rie Ishikawa ◽

Masako Iseki ◽

Rie Koga ◽

Eiichi Inada

Keyword(s):

Neuropathic Pain ◽

Herpes Zoster ◽

Pain Intensity ◽

Visual Analog Scale ◽

Analog Scale ◽

Paindetect Questionnaire ◽

Relationship Of ◽

The Relationship ◽

Over Time

Postherpetic itch (PHI), or herpes zoster itch, is an intractable and poorly understood disease. We targeted 94 herpes zoster patients to investigate their pain and itch intensities at three separate stages of the condition (acute, subacute, and chronic). We used painDETECT questionnaire (PDQ) scores to investigate the correlation between PHI and neuropathic pain. Seventy-six patients were able to complete follow-up surveys. The prevalence of PHI was 47/76 (62%), 28/76 (37%), and 34/76 (45%) at the acute, subacute, and chronic stages, respectively. PHI manifestation times and patterns varied. We investigated the relationship of PHI with neuropathic pain using the visual analog scale (VAS), which is a measure of pain intensity, and the PDQ, which is a questionnaire used to evaluate the elements of neuropathic pain. The VAS and PDQ scores did not differ significantly between PHI-positive and PHI-negative patients. A large neuropathic component was not found for herpes zoster itch, suggesting that neuropathic pain treatments may not able to adequately control the itch. Accordingly, we suggest that a more PHI-focused therapy is required to address this condition.

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Abstract P014: Lower eGFR and Proteinuria Were Independently Associated With Lower Cognitive Abilities in Community-dwelling Men in Japan: SESSA study

Circulation ◽

10.1161/circ.135.suppl_1.p014 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Akira Fujiyoshi ◽

Takayoshi Ohkubo ◽

Katsuyuki Miura ◽

Akihiko Shiino ◽

Naoko Miyagawa ◽

...

Keyword(s):

Cognitive Function ◽

Cognitive Abilities ◽

Estimated Glomerular Filtration Rate ◽

Subclinical Atherosclerosis ◽

Community Dwelling ◽

Community Based ◽

Lower Egfr ◽

The Mean ◽

The Relationship

Introduction: The relationship between chronic kidney disease (CKD) and cognitive function remains to be determined. Existing studies focused primarily on estimated glomerular filtration rate (eGFR) but not proteinuria in relation to cognitive function. Hypothesis: In a community-based sample, lower eGFR and presence of proteinuria are cross-sectionally independently associated with lower cognition. Methods: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) randomly recruited and examined participants from Shiga, Japan in 2006-08 at baseline. Among 824 male participants in the follow-up exam (2010-12), we restricted our analyses to those who underwent the Cognitive Abilities Screening Instrument (CASI), age ≥65 years-old, free of stroke, with no missing pertinent covariates. We calculated eGFR (creatinine-based) according to the 2012-guideline by the Japanese Society of Nephrology. We then divided the participants into three groups by eGFR of ≥60, 59-40, and <40 (mL/min/1.73m 2 ), and separately divided into three groups according to proteinuria using urine dipstick: (-), (-/+), and ≥(1+). We defined CKD as either eGFR <60 or proteinuria ≥ (-/+). In linear regression with CASI score being a dependent variable, we computed the score adjusted for age, highest education attained, smoking, drinking, body mass index, hypertension, diabetes, and dyslipidemia. Results: We analyzed 541 men. The mean [standard deviation] of age and unadjusted score were 72.6 [4.3] years and 89.7 [6.0]. Prevalence of CKD was 56%. The score was significantly lower in participants with CKD than those without it (P=0.03). eGFR and proteinuria categories were separately and jointly associated with lower CASI score in a graded fashion (Ps for trend <0.05 in all the models tested. Table 1 ). Conclusions: Lower eGFR and higher degree of proteinuria were independently associated with lower cognitive function in the community-based men. CKD even in its early phase may predispose to lower cognitive function.

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How Does Health Literacy Modify Indicators of Health Behaviour and of Health? A Longitudinal Study with Trainees in North Germany

Healthcare ◽

10.3390/healthcare10010002 ◽

2021 ◽

Vol 10 (1) ◽

pp. 2

Author(s):

Peter Koch ◽

Zita Schillmöller ◽

Albert Nienhaus

Keyword(s):

Health Status ◽

Health Service ◽

Health Behaviour ◽

Odds Ratio ◽

Well Being ◽

Subjective Health ◽

Subjective Health Status ◽

The Mean ◽

Over Time

Background: Health literacy (HL) is a resource that can help individuals to achieve more control over their health and over factors that influence health. In the present follow-up study, we have investigated the extent to which HL in trainees changes over time and whether or to what extent HL influences health behaviour and health. Methods: In 2017, we performed a baseline survey (T0) of trainees from six different branches, who were contacted through vocational colleges in four northern federal states in Germany. The survey was repeated at the midpoint of their training in 2019 (T1). Demographic data were surveyed, together with information on HL (HLS-EU-Q16), health behaviour and on health status (psychological well-being, subjective health status). Multivariate regression analyses were performed in SPSS 26. Results: Three hundred and ninety-one (391) data sets were evaluated, with a follow-up rate of 27%; 79% of the trainees were female. The mean age was 21.2 years. Over all subjects, the mean HL increased over time ( (SD): 11.9 (2.9) to 12.2 (2.9), p = 0.070). This increase was only statistically significant for the health service trainees ( (SD): 12.1 (2.8) to 12.5 (2.9), p = 0.019). Relative to persons with adequate HL, the odds ratio over time for impaired psychological well-being was increased by 230% in persons with inadequate HL (OR: 3.3, 95% CI: 1.70–6.32, p < 0.001). For persons with problematical HL, the corresponding increase in odds ratio was 110% (OR: 2.1, 95% CI: 1.30–3.38, p = 0.002). Relative to persons with adequate HL, trainees with inadequate HL exhibited a significant increase in odds ratio of 2.8 over time for poor or less good subjective health status (OR: 2.8, 95% CI: 1.23–6.33, p = 0.014). Conclusions: We observed a positive longitudinal association between HL and health. A significant increase in HL was observed in trainees in the health service. Thus the study shows that the concept of HL may provide a potential preventive approach for trainees.

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Is Autonomy Always Beneficial for Work Engagement? A Six-year Four-Wave Follow-Up Study

Journal for Person-Oriented Research ◽

10.17505/jpor.2020.22043 ◽

2020 ◽

Vol 6 (1) ◽

pp. 16-27

Author(s):

Piia Seppälä ◽

Anne Mäkikangas ◽

Jari J. Hakanen ◽

Asko Tolvanen ◽

Taru Feldt

Keyword(s):

Work Engagement ◽

Initial Level ◽

Multilevel Regression ◽

Specific Point ◽

Relationship Patterns ◽

The Mean ◽

Regression Mixture ◽

The Relationship ◽

Predictive Relationship

Work engagement is expected to result from job resources such as autonomy. However, previous results have yielded that the autonomy–work engagement relationship is not always particularly strong. Whereas previous longitudinal studies have examined this relationship as an average at a specific point in time, this study examined whether this relationship is different within individuals from one time to another over the years. Furthermore, experiences of work engagement are expected to affect how employees benefit from autonomy, but no studies have so far investigated whether the initial level of work engagement affects the autonomy–work engagement relationship. This study aimed to first identify the different kinds of longitudinal relationship patterns between autonomy and work engagement, and then to investigate whether the identified relationship patterns differ in terms of the initial mean level of work engagement. The four-wave study was conducted among Finnish managers (n = 329) over a period of six years. Multilevel regression mixture analysis identified five relationship patterns. Four of the patterns showed a positive predictive relationship between autonomy and work engagement. However, the relationship was statistically significant in only one of these patterns. Furthermore, when the initial mean level of work engagement was high, autonomy related more strongly to work engagement. However, an atypical pattern was identified that showed a negative association between autonomy and work engagement. In this pattern, the mean level of work engagement was low. Consequently, autonomy may not always enhance work engagement; sometimes this relationship may even be negative.

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