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Objectively measured activity is not associated with average pain intensity 1 week after surgery: A cross-sectional study.
Get PDFBACKGROUND
Measures of physical activity and pain-related patient-reported outcomes are important components of patient recovery after surgery. However, little is known about their association in the early post-operative period. This study aims to increase this knowledge. Our primary objective was to determine the association between average pain intensity and activity (in steps) 1 week after surgery. Secondary objectives were the association of activity with other patient-reported outcomes, age, sex, comorbidities and body mass index.
METHODS
Data were obtained from the PROMPT sub-project of IMI-PainCare. Patients after breast and endometriosis-related surgery, sternotomy and total knee arthroplasty completed pain-related outcomes questionnaires and wore an ActiGraph activity-tracking device. We correlated steps with average pain intensity on post-operative days 6 and 7. Secondary analyses were done using correlations and t-tests.
RESULTS
In 284 cases, there was no statistically significant correlation between steps and average pain intensity. In addition, none of the 28 secondary analyses showed a statistically significant result.
CONCLUSIONS
Pain-related patient-reported outcome measures and physical activity are separate entities. Both should be measured after surgery to assess patient recovery and to identify treatment deficiencies.
SIGNIFICANCE STATEMENT
Measuring recovery is a multi-dimensional challenge. After surgery, clinicians need to be aware that neither pain intensity nor activity levels tell the whole story. Each can hint to problems and treatment requirements
Isolation of Distinct Networks Driving Action and Cognition in Psychomotor Processes.
No full textBACKGROUND
Psychomotor disturbances are observed across psychiatric disorders and often present as psychomotor slowing, agitation, disorganized behavior, or catatonia. Psychomotor function includes both cognitive and motor components, but the neural circuits driving these subprocesses and how they relate to symptoms have remained elusive for centuries.
METHODS
We analyzed data from the Human Connectome Project for Early Psychosis, a multi-site study of 125 people with early psychosis and 58 healthy participants with resting-state fMRI and clinical characterization. Psychomotor function was assessed using the 9-Hole Pegboard Task, a timed motor task which engages mechanical and psychomotor components of action, and tasks assessing processing speed and task switching. We used multivariate pattern analysis of whole-connectome data to identify brain correlates of psychomotor function.
RESULTS
We identified discrete brain circuits driving the cognitive and motor components of psychomotor function. In our combined sample of psychosis patients (n=89) and non-psychiatric controls (n=52), the strongest correlates of psychomotor function (pegboard performance) (p<.005) were between a midline cerebellar region and (1) left frontal region and (2) pre-supplementary motor area (preSMA). Psychomotor function was correlated with both cerebellar-frontal connectivity (r=0.33) and cerebellar-preSMA connectivity (r=0.27). However, the cognitive component of psychomotor performance (task-switching) was only correlated with cerebellar-frontal connectivity (r=0.19), whereas the motor component (processing speed) was only correlated with cerebellar-preSMA connectivity (r=0.15), suggesting distinct circuits driving unique subprocesses of psychomotor function.
CONCLUSIONS
We identified cerebellar-cortical circuits that drive distinct subprocesses of psychomotor function. Future studies should probe relationships between cerebellar connectivity and psychomotor performance using neuromodulation
Safety and quality of cystectomy and pelvic lymph node dissection after neoadjuvant durvalumab and cisplatin/gemcitabine.
No full textOBJECTIVE
To report on the surgical safety and quality of pelvic lymph node dissection (PLND) in patients treated with radical cystectomy (RC) and PLND for muscle-invasive bladder cancer (MIBC) after neoadjuvant chemo-immunotherapy.
PATIENTS AND METHODS
The Swiss Group for Clinical Cancer Research (SAKK) 06/17 was an open-label single-arm phase II trial including 61 cisplatin-fit patients with clinical stage (c)T2-T4a cN0-1 operable urothelial MIBC or upper urinary tract cancer. Patients received neoadjuvant cisplatin/gemcitabine and durvalumab followed by surgery. Prospective quality assessment of surgeries was performed via central review of intraoperative photographs. Postoperative complications were assessed using the Clavien-Dindo Classification. Data were analysed descriptively.
RESULTS
A total of 50 patients received RC and PLND. All patients received neoadjuvant chemo-immunotherapy. The median (interquartile range) number of lymph nodes removed was 29 (23-38). No intraoperative complications were registered. Grade ≥III postoperative complications were reported in 12 patients (24%). Complete nodal dissection (100%) was performed at the level of the obturator fossa (bilaterally) and of the left external iliac region; in 49 patients (98%) at the internal iliac region and at the right external iliac region; in 39 (78%) and 38 (76%) patients at the right and left presacral level, respectively.
CONCLUSION
This study supports the surgical safety of RC and PLND following neoadjuvant chemo-immunotherapy in patients with MIBC. The extent and completeness of protocol-defined PLND varies between patients, highlighting the need to communicate and monitor the surgical template
Computer-Aided Diagnosis System for Lung Fibrosis: From the Effect of Radiomic Features and Multi-Layer-Perceptron Mixers to Pre-Clinical Evaluation
Get PDFMedical image segmentation is a crucial element of computer-aided diagnosis (CAD) systems. Segmentation maps are used to calculate imaging features, such as quantitative disease distribution and radiomic features. Since their introduction in 2015, UNets have become the state-of-the-art segmentation tools. However, since that time, many new methods for image processing have been introduced, such as vision transformers and multi-layer-perceptron-mixers (MLP-Mixers). Alongside baseline UNets, we have now investigated the application of such MLP-Mixers for medical image segmentation, as part of a CAD system for the diagnosis of interstitial lung diseases (ILDs). Furthermore, we have investigated the effect of 2D and 3D data representations on segmentation and the final CAD results. We have evaluated the performance of the baseline segmentation methods and the MLP-Mixer primary on the overall diagnostic performance of the CAD system - as well as on the accuracy of segmentation as an intermediate step. In addition to network and data representation variations, we have investigated two different techniques for selecting features, an agnostic method and an alternative approach which selects features tailored to a specific segmentation map and diagnosis task. Finally, the CAD’s performance was compared with that of four independent specialists in chest radiology. Among the 105 test cases, the diagnostic accuracy was 77.2±1.6% for the AI-approaches and 79.0±6.9% for the radiologists, indicating that the proposed systems perform comparably well to human readers in most of the cases. For the task of ILD pattern segmentation, similar results were obtained with 3D data and 2D tomography slices
Do Infectious Diseases After Kidney Retransplantation Differ From Those After First Kidney Transplantation?
Get PDFBACKGROUND
Infectious diseases (IDs) are highly relevant after solid organ transplantation in terms of morbidity and mortality, being among the most common causes of death. Patients undergoing kidney retransplantation (re-K-Tx) have been already receiving immunosuppressive therapy over a prolonged period, potentially facilitating subsequent infections. Comparing ID events after re-K-Tx and first kidney transplantation (f-K-Tx) can delineate patterns and risks of ID events associated with prolonged immunosuppression.
METHODS
We included adult patients with records on f-K-Tx and re-K-Tx in the Swiss Transplant Cohort Study. We analyzed ID events after f-K-Tx and re-K-Tx within the same patients and compared infection rates, causative pathogens, and infection sites. Recurrent time-to-event analyses were performed for comparison of infection rates.
RESULTS
A total of 59 patients with a median age of 47 years (range, 18-73) were included. Overall, 312 ID events in 52 patients occurred. In multivariable recurrent event modeling, the rate of ID events was significantly lower after re-K-Tx (hazard ratio, 0.70; P = .02). More bacterial (68.9% vs 60.4%) and fungal (4.0% vs 1.1%) infections were observed after f-K-Tx but fewer viral infections (27.0% vs 38.5%) as compared with re-K-Tx (P = .11). After f-K-Tx, urinary and gastrointestinal tract infections were more frequent; after re-K-Tx, respiratory tract and surgical site infections were more frequent (P < .001).
CONCLUSIONS
ID events were less frequent after re-K-Tx. Affected sites differed significantly after f-K-Tx vs re-K-Tx
Re: 'Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland' by Aghlmandi et al.
No full textExecutive functions in patients with bilateral and unilateral peripheral vestibular dysfunction.
Get PDFPrevious research suggests that patients with peripheral vestibular dysfunction (PVD) suffer from nonspatial cognitive problems, including executive impairments. However, previous studies that assessed executive functions are conflicting, limited to single executive components, and assessments are confounded by other cognitive functions. We compared performance in a comprehensive executive test battery in a large sample of 83 patients with several conditions of PVD (34 bilateral, 29 chronic unilateral, 20 acute unilateral) to healthy controls who were pairwise matched to patients regarding age, sex, and education. We assessed basic and complex executive functions with validated neuropsychological tests. Patients with bilateral PVD performed worse than controls in verbal initiation and working memory span, while other executive functions were preserved. Patients with chronic unilateral PVD had equal executive performance as controls. Patients with acute unilateral PVD performed worse than controls in the exact same tests as patients with bilateral PVD (verbal initiation, working memory span); however, this effect in patients with acute PVD diminished after correcting for multiple comparisons. Hearing loss and affective disorders did not influence our results. Vestibular related variables (disease duration, symptoms, dizziness handicap, deafferentation degree, and compensation) did not predict verbal initiation or working memory span in patients with bilateral PVD. The results suggest that bilateral PVD not only manifests in difficulties when solving spatial tasks but leads to more general neurocognitive deficits. This understanding is important for multidisciplinary workgroups (e.g., neurotologists, neurologists, audiologists) that are involved in diagnosing and treating patients with PVD. We recommend screening patients with PVD for executive impairments and if indicated providing them with cognitive training or psychoeducational support
Dynamic DNA N 6-adenine methylation (6mA) governs the encystment process, showcased in the unicellular eukaryote Pseudocohnilembus persalinus.
No full textThe formation of resting cysts commonly found in unicellular eukaryotes is a complex and highly regulated survival strategy against environmental stress that involves drastic physiological and biochemical changes. Although most studies have focused on the morphology and structure of cysts, little is known about the molecular mechanisms that control this process. Recent studies indicate that DNA N 6-adenine methylation (6mA) could be dynamically changing in response to external stimuli; however, its potential role in the regulation of cyst formation remains unknown. We used the ciliate Pseudocohnilembus persalinus, which can be easily induced to form cysts to investigate the dynamic pattern of 6mA in trophonts and cysts. Single-molecule real-time (SMRT) sequencing reveals high levels of 6mA in trophonts that decrease in cysts, along with a conversion of symmetric 6mA to asymmetric 6mA. Further analysis shows that 6mA, a mark of active transcription, is involved in altering the expression of encystment-related genes through changes in 6mA levels and 6mA symmetric-to-asymmetric conversion. Most importantly, we show that reducing 6mA levels by knocking down the DNA 6mA methyltransferase PpAMT1 accelerates cyst formation. Taken together, we characterize the genome-wide 6mA landscape in P. persalinus and provide insights into the role of 6mA in gene regulation under environmental stress in eukaryotes. We propose that 6mA acts as a mark of active transcription to regulate the encystment process along with symmetric-to-asymmetric conversion, providing important information for understanding the molecular response to environmental cues from the perspective of 6mA modification
Nerve Blocks for Craniotomy.
No full textPURPOSE OF REVIEW
Postcraniotomy headache (PCH) is a common adverse event and can lead to various complications and decreased quality of life.
RECENT FINDINGS
To reduce postcraniotomy pain and associated complications, a multimodal pain therapy including analgesics, analgesic adjuncts, and regional anesthesia is essential. The use of opioids should be minimized to facilitate prompt postoperative neurosurgical assessment. Here, we provide an update on the latest evidence regarding the role of scalp nerve blocks in the pain management of patients undergoing craniotomy procedure. Nerve blocks are effective in alleviating postoperative pain after craniotomy. Scalp blocks contribute to lower pain levels and less opioid consumption in the first 48 h following surgery. Moreover, there is a significant decrease in patients suffering from PONV among patients who receive scalp block
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