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Anatomical Characterization and Topographic Mapping of the Distal Ulnar Nerve and Its Peripheral Branches: A Cadaveric Analysis
No full textBackground: Understanding peripheral ulnar nerve anatomy is necessary to refine surgical treatment of ulnar nerve injuries. This study topographically mapped the ulnar nerve and its distal branch points from a well-defined surgical landmark and assessed for variations in interfascicular motor arrangement and branch size.
Methods: Fifty-four cadaveric upper extremities were dissected to expose the distal ulnar nerve and its branches (dorsal cutaneous (DCB), volar sensory (VSB), and motor branches). The motor branch underwent internal neurolysis to record the topographic orientation of abductor digiti minimi (ADM) and flexor pollicis brevis (FPB) fascicles and the combined intrinsic fascicle identified by its terminal branch (first dorsal interosseus (FDI)). Using a standardized grid system, the branch point location of each terminal branch was measured relative to the hook of the hamate. Diameters of VSB, DCB, and motor fascicles were also measured.
Results: Mean branch point coordinates relative to the hook of the hamate for the FDI were 22.8 mm radial/32.1 mm distal, 13.6 mm radial/25.1 mm distal for FPB, 7.7 mm ulnar/5.2 mm proximal for ADM, and 15.7 mm ulnar/95.3 mm proximal for DCB. The diameters of the VSB, motor branch, and DCB had a mean of 2.3, 1.9, and 1.6 mm, respectively. Proximal to the hook of the hamate, the fascicular arrangement from radial-to-ulnar was VSB, FPB, FDI/intrinsics, ADM, and DCB.
Conclusions: This study provides a complete characterization and mapping of the distal ulnar nerve and its branches to assist surgeons with treatment of ulnar nerve injuries, including nerve transfer
Trends in Reimbursement for All Billable Total Joint Replacement Procedures: An Analysis of the Medicare Part B Database from 2013-2021
Get PDFIntroduction
Total joint arthroplasty (TJA) remains highly prevalent, nearly rivaling the prevalence of other challenging conditions such as heart failure. Annually, there are over 790,000 total knee replacements and more than 450,000 hip replacements performed in the United States. As the demand for TJAs steadily increases, issues related to access, and quality have become increasingly pronounced. Despite the significant annual rise in volume of surgeries, there exists a notable gap pertaining to the epidemiology and reimbursement rates of TJAs within the United States.
Methods
Publicly available data from the Centers for Medicare & Medicaid Services Database was extracted. The dataset was queried to retrieve information on all TJA procedures spanning the years 2013 to 2021. Demographic and reimbursement variables were also analyzed. Furthermore, a regional analysis was performed, categorizing the data based on the United States Census regions. All monetary values in the analyses were adjusted for inflation and statistical significance was indicated by p\u3c 0.05.
Results
From 2013-2021 there was an overall significant increase in total beneficiaries coupled by a significant decrease in Medicare reimbursement over the same time period. Total shoulder arthroplasties had the greatest increase in beneficiaries (124.42%) and greatest decline in Medicare reimbursement (-51.23%). When stratified by region, the Northeast had the greatest mean Medicare reimbursement and the South had the greatest total beneficiaries, with reimbursement significantly declining across all regions.
Conclusion
With an aging United States population, the number of individuals requiring joint arthroplasty procedures is only expected to increase. The results of this study demonstrate an overall decline in reimbursement rates for TJAs coupled with increasing numbers of procedures. This may contribute to increasing strain on orthopedic surgeons and it is crucial to address the factors contributing to these trends. Future studies may seek to further clarify potential implications of this unsustainable trend and explore potential solutions
Morphometry of the Superior Ophthalmic Vein Unaffected by Dilating Factors
No full textContext:Data on the superior ophthalmic vein (SOV) dilation captivate the attention of neurologists as an early sign of several neurovascular disease manifestations, but measurements vary widely in publications.
Aims:This study attempts to shed light on disparate data and develop more stringent criteria for determining the dilation of these veins.
Settings and Design:To this end, 44 orbits of 25 formalin-embalmed human cadavers without risk factors for SOV dilation were dissected.
Materials and Methods:The SOV branching pattern and length were photographed, and multiple segments were analyzed microscopically, histologically, and statistically.
Statistical Analysis Used:Simple descriptive statistics as well as linear regression were used to compare the data.
Results:The mean SOV diameter was 2.05 ± 0.7 mm. Other morphometric findings included the presence of valves and an unreported branching pattern of the SOV.
Conclusion:Knowledge of the mean diameter serves as a diagnostic reference to help recognize SOV dilation, while the unreported variation of SOV (trifurcation at the exit point) may have implications in neurosurgery when using this vein to approach the cavernous sinus
Functionally Refined Encoding of Threat Memory by Distinct Populations of Basal Forebrain Cholinergic Projection Neurons
No full textNeurons of the basal forebrain nucleus basalis and posterior substantia innominata (NBM/SIp) comprise the major source of cholinergic input to the basolateral amygdala (BLA). Using a genetically-encoded acetylcholine (ACh) sensor in mice, we demonstrate that BLA-projecting cholinergic neurons can \u27learn\u27 the association between a naïve tone and a foot shock (training) and release ACh in the BLA in response to the conditioned tone 24h later (recall). In the NBM/SIp cholinergic neurons express the immediate early gene, Fos following both training and memory recall. Cholinergic neurons that express Fos following memory recall display increased intrinsic excitability. Chemogenetic silencing of these learning-activated cholinergic neurons prevents expression of the defensive behavior to the tone. In contrast, we show that NBM/SIp cholinergic neurons are not activated by an innately threatening stimulus (predator odor). Instead, VP/SIa cholinergic neurons are activated and contribute to defensive behaviors in response to predator odor, an innately threatening stimulus. Taken together, we find that distinct populations of cholinergic neurons are recruited to signal distinct aversive stimuli, demonstrating functionally refined organization of specific types of memory within the cholinergic basal forebrain of mice
Anesthetic Considerations for Carbon Dioxide Emboli in Patients with Obesity - A Case Report
No full textGas embolization is a rare but potentially deadly complication of any laparoscopic surgery. There has only been one other report of gas emboli in patients undergoing bariatric surgery. We present a case of gas embolization in a young female patient undergoing Roux-en-Y gastric bypass. Onset of gas embolus was identified by a dramatic drop in End Tidal Carbon Dioxide (ETCO2) followed by drops in blood pressure, heart rate, and oxygen saturation over the following 15 minutes before the patient was stabilized and transferred to the ICU. The surgery was completed three days later without incident, and extensive hepatomegaly was identified. A discussion on pre-operative evaluation, special considerations, and acute management of gas embolization in patients with obesity ensues. We highlight the emerging Jain\u27s point for insufflation, the potential for ultrasound-guided Verres needle insertion, and the paucity of literature evaluating the risk, incidence, and outcomes of gas embolization in patients with obesity
Dual-Task Assessments for Predicting Future Falls in Neurologic Conditions: A Systematic Review
No full textThis review investigated the ability of dual-task tests to predict falls in people with neurological disorders (ND). Databases were searched to identify prospective cohort studies that analyzed dual-task testing and falls in people with NDs. Reviewers screened studies for eligibility and extracted key information like participant characteristics, intervention details, outcome measures, and significant outcomes. Reviewers assessed methodological quality of eligible studies using the Standard Quality Assessment Criteria. 18 studies of strong methodological qualified with 1750 participants were included in the review. Dual-task performances was predictive of future falls in people with Huntington’s disease, spinal cord injury, and moderate cognitive impairment, although only one independent study was included for each disability type. In people with stroke, thirty-seven percent of eligible studies showed dual-task assessments to be predictive of future falls. No dual-task tests predicted prospective falling in people with Alzheimer’s or Parkinson’s disease. Complex dual-tasks appeared to be more predictive of fall risk than simpler dual-tasks. Results suggest that disability type, severity of disability, and task complexity play a role in the predictive ability of dual-task assessments and future falling in NDs. Future studies may benefit from using this review to guide the design of effective dual-task assessments and fall interventions