24 research outputs found

    The “minimal boundary curve for endothermy” as a predictor of heterothermy in mammals and birds: a review

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    According to the concept of the “minimal boundary curve for endothermy”, mammals and birds with a basal metabolic rate (BMR) that falls below the curve are obligate heterotherms and must enter torpor. We examined the reliability of the boundary curve (on a double log plot transformed to a line) for predicting torpor as a function of body mass and BMR for birds and several groups of mammals. The boundary line correctly predicted heterothermy in 87.5% of marsupials (n = 64), 94% of bats (n = 85) and 82.3% of rodents (n = 157). Our analysis shows that the boundary line is not a reliable predictor for use of torpor. A discriminate analysis using body mass and BMR had a similar predictive power as the boundary line. However, there are sufficient exceptions to both methods of analysis to suggest that the relationship between body mass, BMR and heterothermy is not a causal one. Some homeothermic birds (e.g. silvereyes) and rodents (e.g. hopping mice) fall below the boundary line, and there are many examples of heterothermic species that fall above the boundary line. For marsupials and bats, but not for rodents, there was a highly significant phylogenetic pattern for heterothermy, suggesting that taxonomic affiliation is the biggest determinant of heterothermy for these mammalian groups. For rodents, heterothermic species had lower BMRs than homeothermic species. Low BMR and use of torpor both contribute to reducing energy expenditure and both physiological traits appear to be a response to the same selective pressure of fluctuating food supply, increasing fitness in endothermic species that are constrained by limited energy availability. Both the minimal boundary line and discriminate analysis were of little value for predicting the use of daily torpor or hibernation in heterotherms, presumably as both daily torpor and hibernation are precisely controlled processes, not an inability to thermoregulate

    An Algorithmic Approach to Total Breast Reconstruction with Free Tissue Transfer

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    As microvascular techniques continue to improve, perforator flap free tissue transfer is now the gold standard for autologous breast reconstruction. Various options are available for breast reconstruction with autologous tissue. These include the free transverse rectus abdominis myocutaneous (TRAM) flap, deep inferior epigastric perforator flap, superficial inferior epigastric artery flap, superior gluteal artery perforator flap, and transverse/vertical upper gracilis flap. In addition, pedicled flaps can be very successful in the right hands and the right patient, such as the pedicled TRAM flap, latissimus dorsi flap, and thoracodorsal artery perforator. Each flap comes with its own advantages and disadvantages related to tissue properties and donor-site morbidity. Currently, the problem is how to determine the most appropriate flap for a particular patient among those potential candidates. Based on a thorough review of the literature and accumulated experiences in the author's institution, this article provides a logical approach to autologous breast reconstruction. The algorithms presented here can be helpful to customize breast reconstruction to individual patient needs

    Prevalence of Comorbid Psychiatric Conditions and Chronic Pain in Patients Seeking Peripheral Nerve Surgery

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    Background:. In peripheral nerve surgery, the presence of psychiatric diagnoses and medications may affect outcomes and perioperative neuropathic pain management. The purpose of this study was to determine the prevalence of psychiatric diagnoses and chronic pain in patients referred to a peripheral nerve surgery clinic. Methods:. This is a retrospective review of patients seen at a peripheral nerve clinic from July 1, 2017 to June 30, 2021. Medical records were reviewed for demographics; peripheral nerve diagnosis; psychiatric diagnoses; psychotropic prescriptions; use of nonneuroleptic/nonnarcotic, neuroleptic, and narcotic medications; and peripheral nerve surgical candidacy and outcome. Results:. Six hundred twenty-two patients were included in this study. The most common reasons for referral were 24.8% lower extremity neuroma, 23.2% lower extremity compressive neuropathy, and 14.0% upper extremity compressive neuropathy. Of the included patients‚ 37.1% had a psychiatric diagnosis, and 36.3% were taking a psychotropic medication. The percentage of patients taking chronic nonneuroleptic/nonnarcotic pain medications was 34.3%‚ with 42.8% taking neuroleptic, and 24.9% narcotic medications. Patients with a psychiatric diagnosis were more likely to be taking neuroleptic (48.9% versus 38.9%, P < 0.001) and narcotic pain medications (27.3% versus 17.4%, P = 0.004) and less likely to have a positive surgical outcome (65.7% versus 83.0%, P = 0.001). Conclusions:. Patients referred to a peripheral nerve surgery clinic frequently have psychiatric diagnoses and take chronic psychotropic and chronic pain medications. Knowledge of this will best help the peripheral nerve surgeon evaluate a patient for surgery, optimize perioperative care, and safely and effectively manage expectations

    A Consensus Approach for Targeted Muscle Reinnervation in Amputees

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    Amputations have been performed with few modifications since the dawn of surgery. Blood vessels are ligated, bones are shortened, and nerves are cut. In a percentage of people, this can result in severe neuropathic, residual limb, and phantom limb pain. Targeted muscle reinnervation is a surgical procedure initially conceived to optimize function for myoelectric prostheses in amputees. Recently, it has been adopted more widely by surgeons for the prevention and treatment of neuropathic pain. Perhaps as a function of its relatively recent development, many authors perform this operation differently, and there has been no overall agreement regarding the principles, indications, technical specifics, and postoperative management guidelines. This article is written as a consensus statement by surgeons focused on the treatment of neuropathic pain and those with extensive experience performing targeted muscle reinnervation. It is designed to serve as a roadmap and template for extremity surgeons to consider when performing targeted muscle reinnervation

    The eastern extent of the Barents-Kara ice Sheet during the Last Glacial Maximum based on seismic-reflection data from the eastern Kara Sea

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    We present sub-bottom profiling (sparker and Parasound) results from the eastern Kara Sea, on the Eurasian Arctic margin, which enable the identification of the Last Glacial Maximum (LGM) ice extent. The analysed profiles show that glacigenic diamicton is ubiquitous at the seafloor, east of about 95°E and 78°N. The eastern margin of this diamicton is expressed in a conspicuous morainic ridge at the entrance to the Vilkitsky Strait, and to the south the diamicton projection aligns with the LGM limit mapped at the north-western Taymyr. The bottom of the Voronin Trough further north is also covered with diamicton and has numerous erosional bedforms, indicating a streamlined flow of grounded ice along the trough. Accurate dating of the diamicton is not attainable, but the correlation of pre-diamict sediments to well-dated sections in the Laptev Sea, and available 14C ages from sediments on top of the diamicton, indicate its LGM age. These results support the palaeogeographic reconstruction that assumes the extension of the LGM Barents–Kara ice sheet as far east as Taymyr. This configuration implies that LGM ice blocked the drainage of the Ob and Yenisey rivers on the Kara shelf. This inference is consistent with the presence of large (>100 km wide) lenses of basin infill adjacent to the southern margin of the diamicton. However, the limited distribution of the eastern Kara ice lobe, not extending on Severnaya Zemlya, suggests that the ice was fairly thin and short-lived: insufficient for the accumulation of the gigantic proglacial lakes that occurred during earlier glaciations
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