The association of body representation and nociceptive sensitivity measures with shoulder pain and disability prior to and twelve months after shoulder surgery

Multidimensional factors have been identified for the development and persistence of shoulder pain. More recently alterations in the Central Nervous System (CNS) have been identified in musculoskeletal pain. This study aimed to determine the association between measures of body representation and nociceptive sensitivity, and shoulder pain and disability prior to and 12 months following rotator cuff surgery. Measures indicative of altered CNS processing were related to pain and disability prior to but not following surgery

Rotablation im klinischen Alltag: Radialer versus femoraler Zugangsweg

Zusammenfassung Hintergrund und Zielsetzung: Die Rotablation stellt ein bewährtes Verfahren zur Therapie schwer verkalkter und komplexer Koronarläsionen dar. Während sich der radiale Gefäßzugang als Standard-Gefäßzugang für die konventionelle Koronarintervention etabliert hat, wird für die Rotablation häufig der femorale Gefäßzugang bevorzugt. Die Auswahl des Zugangswegs für die Rotablation begründet sich u.a. im kleineren Gefäßdurchmesser der A. radialis im Vergleich zur A. femoralis, der häufig zu Bedenken in Anbetracht der dadurch einsetzbaren Größe an Schleusen, Führungskathetern sowie Bohrköpfen führt. Darüber hinaus spielt auch die mögliche Notwendigkeit eines passageren Schrittmachers eine Rolle bei der Auswahl des Gefäßzugangs. Ziel dieser Arbeit war, Anwendungsunterschiede des Zugangswegs im klinischen Alltag und dabei dessen Einfluss auf prozedurale Aspekte der Rotablation sowie den prozeduralen Erfolg zu untersuchen. Methoden: Bei dieser Arbeit handelt es sich um eine retrospektive, monozentrische Datenanalyse, die ein Kollektiv von 228 Patienten, die im Zeitraum vom 03/2013 bis 06/2019 mittels Rotablation in der Medizinischen Klinik 2 des Universitätsklinikums Erlangen (Kardiologie und Angiologie) behandelt wurden, umfasst. Die Datenanalyse erfolgte nach Aufteilung der Patienten in eine radiale (78 Patienten, 34,2 %) sowie eine femorale (150 Patienten, 65,8 %) Gruppe, gemäß des zur Rotablation gewählten Gefäßzugangs. Ergebnisse und Beobachtungen: Beide Gruppen zeigten ähnliche Baseline Charakteristika, kardiale Vorerkrankungen und kardiovaskuläre Risikofaktoren. Unterschiede zwischen der radialen und femoralen Gruppe ließen sich bei Betrachtung des Body Mass Index (radial 27,1±4,8 kg/m2 vs. femoral 28,1±4,5 kg/m2; p=0,030), der Prävalenz eines Diabetes mellitus (radial 24,4 % vs. femoral 38,0 %; p=0,038), den präinterventionell gemessenen Kreatininwerten (radial 0,95±0,29 mg/dL vs. femoral 1,30±1,09 mg/dL; p=0,006) und der Anzahl dialysepflichtiger Nierenerkrankungen (radial 0 % vs. femoral 5,3%, p=0,038) verzeichnen. Diese waren bei Patienten mit femoralem Gefäßzugang signifikant höher als bei jenen mit transradialer Rotablation. Darüber hinaus verzeichneten Patienten der femoralen Gruppe eine signifikant geringere linksventrikuläre Ejektionsfraktion (radial 53±11 % vs. femoral 48±13 %; p=0,007). In beiden Gruppen erfolgte die Rotablation am häufigsten über 7 F Schleusen (radial 52,6 % vs. femoral 75,3 %; p<0,001). Ein signifikanter Unterschied ließ sich für 6 F Gefäßschleusen, die häufiger bei transradialer Rotablation verwendet wurden, verzeichnen (radial 47,4% vs. femoral 16,7%, p<0,001). Innerhalb der femoralen Gruppe erfolgte die Koronarintervention hingegen signifikant häufiger über 7 oder 8 F Schleusen (7 F: radial 52,6 % vs. femoral 75,3 %; p<0,001; 8 F: radial 0 % vs. femoral 8,0 %; p=0,010). Trotz des Einsatzes von insgesamt kleineren Schleusen und Führungskathetern innerhalb der radialen Gruppe, zeigten sich keine Unterschiede zwischen den untersuchten Kollektiven bei Betrachtung der zur Rotablation gewählten mittleren maximalen Bohrkopfgröße (radial 1,43±0,17 mm vs. femoral 1,41±0,18 mm, p=0,442). Ein passagerer Schrittmacher wurde bei Patienten der radialen Gruppe vergleichbar oft wie bei Patienten der femoralen Gruppe eingesetzt (radial 20,8 % vs. femoral 30,8 %; p=0,110). Ein statistisch signifikanter Unterschied zwischen beiden Gruppen ließ sich erst bei zusätzlicher Betrachtung der permanenten Schrittmacherversorgung verzeichnen - so waren Patienten der femoralen im Vergleich zu Patienten der radialen Gruppe signifikant häufiger durch einen permanenten oder passageren Schrittmacher vor rhythmologischen Komplikationen der Rotablation geschützt (radial 24,7 % vs. femoral 39,0 %; p=0,031). Es ließen sich keine signifikanten Unterschiede zwischen beiden Gruppen im Hinblick auf die mittlere Fluoroskopiezeit (radial 22:24±14:29 min vs. femoral 24:41±16:01 min, p=0,206) sowie den mittleren Kontrastmittelverbrauch (radial 200±150 ml vs. femoral 180±110 ml, p=0,121) erkennen. Darüber hinaus verzeichneten beide Gruppen eine vergleichbare periprozedurale Komplikationsrate (radial 6,4 % vs. femoral 9,3 %; p=0,449). Schlussfolgerungen: Die Ergebnisse dieser Datenanalyse zeigen, dass die Rotablation über den radialen Gefäßzugang genauso sicher und effektiv ist wie über den femoralen Zugangsweg. Trotz des kleineren Gefäßdurchmessers der A. radialis im Vergleich zur A. femoralis sowie der Verwendung von insgesamt kleineren Schleusen und Führungskathetern innerhalb der radialen Gruppe, konnten keine Einschränkungen der dadurch einsetzbaren Bohrkopfgröße zur optimalen Plaque-Modifikation beobachtet werden. Darüber hinaus deuteten weder die Interventionsdauer, noch die Fluoroskopiezeit, der Kontrastmittelbedarf oder die periprozedurale Komplikationsrate auf eine höhere Komplexität des radialen Gefäßzugangs für die Rotablation hin

Hyperpolarization-Enhanced NMR Spectroscopy of Unaltered Biofluids Using Photo-CIDNP

Altres ajuts: acords transformatius de la UABThe direct and unambiguous detection and identification of individual metabolite molecules present in complex biological mixtures constitute a major challenge in (bio)analytical research. In this context, nuclear magnetic resonance (NMR) spectroscopy has proven to be particularly powerful owing to its ability to provide both qualitative and quantitative atomic-level information on multiple analytes simultaneously in a noninvasive manner. Nevertheless, NMR suffers from a low inherent sensitivity and, moreover, lacks selectivity regarding the number of individual analytes to be studied in a mixture of a myriad of structurally and chemically very different molecules, e.g., metabolites in a biofluid. Here, we describe a method that circumvents these shortcomings via performing selective, photochemically induced dynamic nuclear polarization (photo-CIDNP) enhanced NMR spectroscopy on unmodified complex biological mixtures, i.e., human urine and serum, which yields a single, background-free one-dimensional NMR spectrum. In doing this, we demonstrate that photo-CIDNP experiments on unmodified complex mixtures of biological origin are feasible, can be performed straightforwardly in the native aqueous medium at physiological metabolite concentrations, and act as a spectral filter, facilitating the analysis of NMR spectra of complex biofluids. Due to its noninvasive nature, the method is fully compatible with state-of-the-art metabolomic protocols providing direct spectroscopic information on a small, carefully selected subset of clinically relevant metabolites. We anticipate that this approach, which, in addition, can be combined with existing high-throughput/high-sensitivity NMR methodology, holds great promise for further in-depth studies and development for use in metabolomics and many other areas of analytical research

The National Dutch Breast Implant Registry: user-reported experiences and importance

Background: Robust (inter-)national breast implant registries are important. For some, registries are an administrative burden, for others they represent a solution for the discussions involving breast implants. The DBIR is one of the first national, opt-out, clinical registries of breast implants, providing information for clinical auditing and product recall. Four years after its introduction, it is time to address users’ comments in order to keep improving quality of registration, and patient safety. This study assesses users’ feedback focusing on importance of registration, logistics and user experience, and areas of improvement. Methods: In May 2018, a standardized online study–specific questionnaire was sent out to all members of the Netherlands Society of Plastic Surgery. Descriptive statistics were reported in absolute frequencies and/or percentages. Results: A total of 102 members responded to the questionnaire (response rate, 24.2%). Of all respondents, 97.1% were actively registering in DBIR. Respondents rated the importance of registration in DBIR as 8.1 out of 10 points. Ninety-one respondents suggested improvements for the DBIR. All comments were related to registration convenience and provision of automatically generated data. Conclusions: Respondents believe that registration is highly important and worth the administrative burden. However, we should collectively keep improving accuracy, usability and sustainability of breast

Rotational atherectomy via the transradial access: success rates, procedural parameters and complications

Radial access is recommended for percutaneous coronary intervention (PCI), but rotational atherectomy remains frequently performed via femoral access. Analyzing the procedural parameters, success rate and complications of rotational atherectomy, performed via radial in comparison to femoral access. We retrospectively analyzed 427 consecutive patients undergoing rotational atherectomy. Procedural parameters and outcome were determined in 171 patients, scheduled for radial and compared to 256 patients with femoral access use. In the radial access group (74 ± 9 years, 84% male), the LAD was most frequently treated (49%). Sheath size was 7F in 59% and 6F in 41%, burr size was 1.5 mm in 46% and 1.25 mm in 14% of patients. A temporary pacemaker was inserted in 14%. Procedural success rate stood at 97%. Access site complications occurred in 4% of patients, which was significantly less frequent than in in 256 patients treated via femoral access (13% p  = 0.003). Compared to radial access, femoral access was associated with the use of larger sheaths ( p  < 0.001), more frequent treatment of non-LAD vessels (58.2% vs. 44.4%, p  = 0.013) and a higher rate of temporary pacemaker use (27%; p  = 0.001). No differences could be seen in procedural success ( p  = 0.83) and burr size ( p  = 0.51). Femoral access (OR 3.33; 95% CI 1.40–7.93), and female sex (OR3.40 95% CI 1.69–6.63) were independent predictors for access site complications. For coronary rotational atherectomy, radial access has a high success rate with overall use of smaller sheaths, but of equally sized burrs as well as a significant lower rate of access site-related complications than femoral access.Open Access funding enabled and organized by Projekt DEAL.Friedrich-Alexander-Universität Erlangen-Nürnberg (1041

Observation of the solid-state photo-CIDNP effect in entire cells of cyanobacteria Synechocystis

Cyanobacteria are widely used as model organism of oxygenic photosynthesis due to being the simplest photosynthetic organisms containing both photosystem I and II (PSI and PSII). Photochemically induced dynamic nuclear polarization (photo-CIDNP) 13C magic-angle spinning (MAS) NMR is a powerful tool in understanding the photosynthesis machinery down to atomic level. Combined with selective isotope enrichment this technique has now opened the door to study primary charge separation in whole living cells. Here, we present the first photo-CIDNP observed in whole cells of the cyanobacterium Synechocystis

Clinical and patient-reported outcomes after oncoplastic vs conventional breast-conserving surgery - a longitudinal, multicenter cohort study

BackgroundOncoplastic breast-conserving surgery (OP-BCS) is becoming increasingly popular to avoid mastectomy or optimize cosmetic outcomes of breast-conserving surgery (BCS). Few studies have compared clinical outcomes and patient-reported outcomes (PROs) of OP-BCS to conventional BCS (C-BCS). This study aims to compare clinical outcomes and short- and long-term PROs after OP-BCS and C-BCS in a large prospective breast cancer cohort.MethodsWomen in the prospective, multicenter UMBRELLA (Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaLuAtion) breast cancer cohort who underwent OP-BCS or C-BCS were included. Clinical outcomes and PROs (measured by EORTC QLQ-C30/BR23) up to 24 months postoperatively were evaluated. Mixed-model analysis was performed to assess differences in PROs over time between groups.ResultsA total of 1628 (84.9%) patients received C-BCS and 290 (15.1%) received OP-BCS. After C-BCS and OP-BCS, free resection margins were obtained in 84.2% (n = 1370) and 86.2% (n = 250), respectively, reoperation for re-excision of margins within 3 months occurred in 5.3% (n = 86) and 4.8% (n = 14), and the median time interval from surgery until adjuvant systemic therapy was 66 and 63 days, and 36 and 41 days until radiotherapy. Shortly postoperative, OP-BCS was associated with statistically significant lower mean scores for physical functioning (83.6 vs 87.2) and body image (82.8 vs 89.4) and more pain (19.8 vs 26.5) and breast symptoms (22.7 vs 30.3) than C-BCS. Body image scores remained statistically significantly less favorable after OP-BSC than C-BCS up to 24 months postoperatively (87.8 vs 92.2).ConclusionsOncoplastic surgery safely enables BCS but may lead to less favorable long-term body image compared to C-BCS. These findings are important for patient education and shared decision-making

Efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours: systematic review

BACKGROUND: Accurate tumour localization is crucial for precise surgical targeting and complete tumour removal. Indocyanine green fluorescence, an increasingly used technique in oncological surgery, has shown promise in localizing non-palpable breast tumours. The aim of this systematic review was to describe the efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours. METHODS: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library, including studies from 2012 to 2023. Studies reporting the proportion of breast tumours identified using indocyanine green fluorescence were included. The quality of the studies and their risk of bias were appraised using the Methodological Index for Non-Randomized Studies ('MINORS') tool. The following outcomes were collected: identification rate, clear resection margins, specimen volume, operative time, re-operation rate, adverse events, and complications. RESULTS: In total, 2061 articles were screened for eligibility, resulting in 11 studies, with 366 patients included: two RCTs, three non-randomized comparative studies, four single-arm studies, and two case reports. All studies achieved a 100 per cent tumour identification rate with indocyanine green fluorescence, except for one study, with an identification rate of 87 per cent (13/15). Clear resection margins were found in 88-100 per cent of all patients. Reoperation rates ranged from 0.0 to 5.4 per cent and no complications or adverse events related to indocyanine green occurred. CONCLUSION: Indocyanine green fluorescence has substantial theoretical advantages compared with current routine localization methods. Although a limited number of studies were available, the current literature suggests that indocyanine green fluorescence is a useful, accurate, and safe technique for the intraoperative localization of non-palpable breast tumours, with equivalent efficacy compared with other localization techniques, potentially reducing tumour-positive margins