Acute post-traumatic muscle atrophy on CT scan predicts prolonged mechanical ventilation and a worse outcome in severe trauma patients

BackgroundThe aim of present study was to assess the association between acute post-traumatic atrophy (APTMA) determined on psoas computed tomography [CT] scan and the duration of mechanical ventilation and outcomes in severe trauma patients.MethodsA retrospective analysis of severe trauma patients (Injury Severity Score [ISS], >15) hospitalized in the intensive care unit (ICU) for more than 7 days between January 2010 and December 2015 was performed. The psoas muscle index (PMI) was measured on admission and at delayed CT scan. ΔPMI was calculated as the percentage PMI loss between these two scans. Three groups were defined and compared a posteriori using the quartiles of the ΔPMI values: low (lower quartile), moderate, and severe (higher quartile) APTMA groups. Linear regression analysis was performed to predict the duration of mechanical ventilation, of catecholamines, length of stay (LOS) in the ICU and hospital, and complications were assessed.ResultsA total of 114 trauma patients were included (median age, 40 years; [IQR, 25–54 years]; ISS, 33 [IQR, 25–41]). Based on the ΔPMI determination, 29 patients were allocated in the low APTMA group (range ?PMI, 0%–6%), 56 in the moderate APTMA group (range ?PMI, 6%–18%), and 29 in the APTMA group (range ?PMI, ≥19%). Severity of APTMA was significantly associated with the duration of mechanical ventilation and catecholamines, ICU and hospital LOS (P<0.001). Delayed pneumonia (P=0.006) and other delayed infections (P=0.014), as well as thromboembolic events (P=0.04) were statistically associated with the severity of APTMA, whereas mortality did not differ between the three groups (P=0.20). Using linear regression analysis, each ?PMI increase of 1% was significantly associated with 0.90 supplementary days of mechanical ventilation (P<0.001), 0.29 supplementary days of catecholamines (P<0.001) and 0.82 supplementary days of hospitalization (P<0.001). All these statistical associations were confirmed in multivariate analysis (P<0.001).ConclusionAcute muscle atrophy diagnosed on CT scan by psoas area measurement (ΔPMI) was strongly associated with poor outcomes in severe trauma patients.     

Bibliometric analysis of orthopaedic related publications by Indian authors from the last decade

PurposeBibliometric studies have been established methods of analysing publications on a particular topic. These studies have been done on various orthopaedic topics and are increasing. The advantages of these studies have been highlighted in previous publications. Although some studies have been done on Indian publications from other specialties, those analysing Indian Orthopaedic Publications are lacking.MethodsWe performed a search in Scopus to look for all publications related to orthopaedics from India. Our search strategy in Scopus included ((TITLE-ABS-KEY(Orthopaedics OR Orthopaedics) AND AFFIL(India)) AND PUBYEAR > 2009 AND PUBYEAR < 2020) which resulted in 3270 articles on 02/11/2021. We analyzed the most publishing universities, city, state, specialty, authors, and anatomic location of these publications. We also mined the data to draw word clouds based on data obtained from the titles of articles, keywords and the affiliations of each of the articles published.ResultsTamil Nadu and New Delhi and their institutes appear to be the epicenter of publication activities in Orthopaedics in India. There has been a healthy trend of growth of articles in the orthopaedic specialty. Since there is a significant overlap of technology and engineering, it is not surprising to see engineering and technology institutes among the top 10 published institutes and even journals for the publications on orthopaedics.ConclusionThere has been a steady increase in the number of publications in the last decade. New Delhi and its Universities and Institutes appear to contribute the majority of citations and publications related to orthopaedics. Journal of Clinical Orthopaedics and Trauma was the most publishing journal for Indian authors on Orthopaedic related articles.     

Intraoperative cerebral blood flow monitoring in neurosurgery: A review of contemporary technologies and emerging perspectives

Intraoperative monitoring of cerebral blood flow (CBF) has become an invaluable adjunct to vascular and oncological neurosurgery, reducing the risk of postoperative morbidity and mortality. Several technologies have been developed during the last two decades, including laser-based techniques, videomicroscopy, intraoperative MRI, indocyanine green angiography, and thermography. Although these technologies have been thoroughly studied and clinically applied outside the operative room, current practice lacks an optimal technology that perfectly fits the workflow within the neurosurgical operative room. The different available technologies have specific strengths but suffer several drawbacks, mainly including limited spatial and/or temporal resolution. An optimal CBF monitoring technology should meet particular criteria for intraoperative use: excellent spatial and temporal resolution, integration in the operative workflow, real-time quantitative monitoring, ease of use, and non-contact technique. We here review the main contemporary technologies for intraoperative CBF monitoring and their current and potential future applications in neurosurgery.     

Multisegment Foot Models and Clinical Application After Foot and Ankle Trauma: A Review

Since the end of the 1990s, several multisegment foot models (MSFMs) have been developed. Several models were used to describe foot and ankle kinematics in patients with foot and ankle pathologies; however, the diagnostic value for clinical practice of these models is not known. This review searched in the literature for studies describing kinematics in patients after foot and ankle trauma using an MSFM. The diagnostic value of the MSFMs in patients after foot and ankle trauma was also investigated. A search was performed on the databases PubMed/MEDLINE, Embase, and Cochrane Library. To investigate the diagnostic value of MSFMs in patients after foot and ankle trauma, studies were classified and analyzed following the diagnostic research questions formulated by Knottnerus and Buntinx. This review was based on 7 articles. All studies were published between 2010 and 2015. Five studies were retrospective studies, and 2 used an intervention. Three studies described foot and ankle kinematics in patients after fractures. Four studies described foot and ankle kinematics in patients after ankle sprain. In all included studies, altered foot and ankle kinematics were found compared with healthy subjects. No results on patient outcome using MSFMs and costs were found. Seven studies were found reporting foot and ankle kinematics in patients after foot and ankle trauma using an MSFM. Results show altered kinematics compared with healthy subjects, which cannot be seen by other diagnostic tests and add valuable data to the present literature; therefore, MSFMs seem to be promising diagnostic tools for evaluating foot and ankle kinematics. More research is needed to find the additional value for MSFMs regarding patient outcome and costs.