The ABA intervention for improving breastfeeding initiation and continuation: Feasibility study results

The UK has low breastfeeding rates, with socioeconomic disparities. The Assets‐based feeding help Before and After birth (ABA) intervention was designed to be inclusive and improve infant feeding behaviours. ABA is underpinned by the behaviour change wheel and offers an assets‐based approach focusing on positive capabilities of individuals and communities, including use of a Genogram. This study aimed to investigate feasibility of intervention delivery within a randomised controlled trial (RCT). Nulliparous women ≥16 years, (n = 103) from two English sites were recruited and randomised to either intervention or usual care. The intervention – delivered through face‐to‐face, telephone and text message by trained Infant Feeding Helpers (IFHs) – ran from 30‐weeks' gestation until 5‐months postnatal. Outcomes included recruitment rates and follow‐up at 3‐days, 8‐weeks and 6‐months postnatal, with collection of future full trial outcomes via questionnaires. A mixed‐methods process evaluation included qualitative interviews with 30 women, 13 IFHs and 17 maternity providers; IFH contact logs; and fidelity checking of antenatal contact recordings. This study successfully recruited women, including teenagers, from socioeconomically disadvantaged areas; postnatal follow‐up rates were 68.0%, 85.4% and 80.6% at 3‐days, 8‐weeks and 6‐months respectively. Breastfeeding at 8‐weeks was obtained for 95.1% using routine data for non‐responders. It was possible to recruit and train peer supporters to deliver the intervention with adequate fidelity. The ABA intervention was acceptable to women, IFHs and maternity services. There was minimal contamination and no evidence of intervention‐related harm. In conclusion, the intervention is feasible to deliver within an RCT, and a definitive trial required.     

Does Surgical Approach Influence the Natural History of the Unstable Total Hip Arthroplasty?

BackgroundDislocation following total hip arthroplasty (THA) is a significant complication that occurs in 0.3%-10% of cases with 13%-42% of patients requiring revision surgery. The literature has primarily focused on the dislocation risk associated with different surgical approaches. However, little is known about the natural history of the dislocated hip and whether surgical approach of the index THA is associated with further instability and revision surgery.MethodsThis is a retrospective, single-center, multi-surgeon consecutive case series of all patients who experienced THA dislocation from 2002 to 2020. Patients were excluded if the initial dislocation was secondary to infection or fracture. The natural history of the cohort as per approach was determined. Outcome measurements of interest were the number of dislocations; the treatment surrounding each dislocation; the necessity and type of revision; and the complications encountered.ResultsOf the 75 patients, 58 (77%) dislocated within 6 months following primary THA. The anterior group had greater odds of dislocation within 2 weeks post-THA compared to the lateral and posterior groups (P = .04). The mean number of dislocations per patient was significantly lower in the anterior (1.5 ± 0.7) compared to the lateral (2.4 ± 1.2) and posterior (2.1 ± 1.0) groups (P = .02). Revision surgery was needed in 30% (6/20) of patients in the anterior, 69% (25/36) of the posterior, and 68% (13/19) of the lateral groups (P = .01).ConclusionThis study illustrates that while primary THA dislocations happen earlier with the anterior approach, they are typically less complicated and have a lower risk of recurrent instability and revision surgery.     

Perioperative Complications Stratified by Body Mass Index for the Direct Anterior Approach to Total Hip Arthroplasty

BackgroundPrevious studies have addressed the increased risk of perioperative complications in the obese and morbidly obese populations undergoing total hip arthroplasty. Over the last 15 years, the direct anterior approach has increased in popularity. The purpose of this study is to compare the 90-day perioperative complication rate of total hip arthroplasty performed through the direct anterior approach stratified by body mass index (BMI).MethodsPerioperative complications both intraoperative and up to 90 days postoperative were identified in a case series of 1808 primary total hip arthroplasties performed through a direct anterior approach. The patients were stratified according to BMI. Demographics of age, side, sex, and American Society of Anesthesiologists score were recorded. Medical and surgical complications including National Surgical Quality Improvement Program complications, length of stay, reoperation rate, readmission rate, and length of operation were recorded. Bivariate analysis and analysis of variance were performed.ResultsMorbidly obese patients (BMI > 40) demonstrated increased American Society of Anesthesiologists scores, increased surgical times with statistically significant increase in number of patients with surgical complications, National Surgical Quality Improvement Program complications, deep infection, and wound breakdown. Grading the severity of complications also demonstrated the morbidly obese had a higher risk of experiencing more severe complications. Underweight patients (BMI < 18.5) demonstrated a statistically significant readmission rate.ConclusionIn stratifying patients undergoing the direct anterior approach for total hip arthroplasty by BMI, a greater rate of surgical complications both in number and in severity occurs with the morbidly obese undergoing total hip arthroplasty through a direct anterior approach.     

Schwannoma del glosofaríngeo: reporte de caso clínico

Schwannomas of the glossopharyngeal nerve are extremely rare tumors of the posterior fossa. In a 100-year review, a total of 42 cases were found between 1908-2008. The most common clinical data are associated with its location, the most common being cochlear vestibule symptoms and symptoms of glossopharyngeal nerve function. its diagnosis has now been facilitated by the use of magnetic resonance, however, it is very complicated to define preoperatively if the tumor originates from the ix, x or xi NC. We present the case of a 42-year-old patient with a syndrome of angulopentocerebellar syndrome, posterior torn (jugular) hole syndrome + anterior condyle (Collet-Sicard). The treatment used was surgical with transcondylar lateral extreme approach, with monitoring of cranial nerves and trans-operative evoked potentials.     

经后颅窝乙状窦后入路三叉神经微血管减压术的快速康复外科护理

目的 探讨快速康复外科 （FTS）理念在经后颅窝乙状窦后入路三叉神经微血管减压术围术期患者护理中的应用效果。方法 选择2018年1月~2019年1月我院收治并行经后颅窝乙状窦后入路三叉神经微血管减压患者100例，随机分成观察组和对照组，每组50例。对照组应用常规方法进行围术期护理，观察组应用FTS理念进行围术期护理。比较两组焦虑情况、术后并发症发生率、平均住院日及平均住院费用。结果 观察组轻度焦虑多于对照组，中、重度焦虑少于对照组（P＜0.05）；观察组术后并发症发生率低于对照组[恶心呕吐（4.00% vs 16.00%）、尿路感染（4.00% vs 18.00%）、颅内感染（0 vs 8.00%）、颅内血肿（2.00% vs 14.00%）和术后应激性疼痛（16.00% vs 34.00%）]，差异有统计学意义（P＜0.05）；观察组平均住院日和平均住院费用均低于对照组[（9.13±1.14）d vs（12.44±0.89）d]；[（2.15±0.66）万元 vs （3.05±0.61）万元]，差异有统计学意义（P＜0.05）。结论 应用FTS理念能缓解经后颅窝乙状窦后入路三叉神经微血管减压术患者术前紧张恐惧的心理，减少术后并发症，缩短患者住院日，降低住院费用，护理效果较好。     

Ectopic Cervical Thymoma Excised through a Transcervical Approach Combined with Video-assisted Thoracoscopic Surgery: A Case Report

Ectopic cervical thymoma (ECT) is a rare tumor. We present a case of 56-year-old woman with an ECT in the anterior neck that was correctly diagnosed preoperatively. The patient had no symptoms of myasthenia gravis or other immune disorders, and the tumor was not invading any adjacent structures. We performed tumor resection and thymectomy through a transcervical approach using video-assisted thoracoscopic surgery with a multi-access single port. To our knowledge, this is a novel combined technique for the resection of an ECT.     

神经内镜辅助下经鼻蝶入路治疗鞍区肿瘤

目的探讨神经内镜辅助下经鼻蝶入路切除鞍区肿瘤的方法和优势。方法回顾性分析30例鞍区肿瘤病人的临床资料,垂体腺瘤26例(其中无功能垂体腺瘤6例、泌乳素瘤16例、垂体生长激素腺瘤4例),拉克囊肿1例,胆脂瘤1例,脑膜瘤1例,颅咽管瘤1例。采用神经内镜辅助下经鼻蝶入路手术切除肿瘤。结果肿瘤全切27例,部分切除3例。术后3例发生脑脊液鼻漏,经腰大池持续引流后痊愈。无死亡病例。随访3~6个月,病人恢复良好。结论在神经内镜辅助下经鼻蝶入路治疗鞍区肿瘤,较单纯的显微镜手术治疗创伤更小,肿瘤全切率更高。     

The role of the ventral striatum in inflammatory-induced approach toward support figures

Although considerable research has shown that inflammation leads to social withdrawal more generally, it is also possible that inflammation leads to social approach when it comes to close others. Whereas it may be adaptive to withdraw from strangers when sick, it may be beneficial to seek out close others for assistance, protection, or care when sick. However, this possibility has never been explored in humans nor have the neural substrates of these behavioral changes. Based on the role of the ventral striatum (VS) in responding to: (1) the anticipation of and motivation to approach rewarding outcomes and (2) viewing social support figures, the VS may also be involved in sickness-induced approach toward support figures. Thus, the goal of the present study was to examine whether inflammation leads to a greater desire to approach support figures and greater VS activity to viewing support figures. To examine this, 63 participants received either placebo or low-dose endotoxin, which safely triggers an inflammatory response. Participants reported how much they desired to be around a self-identified support figure, and viewed pictures of that support figure while undergoing an fMRI scan to assess reward-related neural activity. In line with hypotheses, endotoxin (vs. placebo) led participants to report a greater desire to be around their support figure. In addition, endotoxin (vs. placebo) led to greater VS activity to images of support figures (vs. strangers), and greater increases in inflammation (IL-6 levels) were associated with greater increases in VS activity. Together, these results reveal a possible neural mechanism important for sickness-induced social approach and highlight the need for a more nuanced view of changes in social behavior during sickness.     

From confusion to consensus: Need for multi disciplinary team approach in rheumatology: An orthopaedic surgeons's perpective

Aim of joint surgeries in rheumatoid arthritis is to restore function and quality of life, prevent joint deterioration, relieve pain and correct deformity in patients afflicted with rheumatoid disorders With advent of newer therapeutic modalities, the need for joint surgeries in cases of rheumatoid disorders has drastically reduced over the past two decades. Decision-making and timing for orthopaedic intervention are complex issues because of polyarticular involvement in rheumatoid disorder. Optimal results from the surgery demands close team work between the rheumatologists and the orthopaedic surgeon. However, as studies, have indicated, there appears to be divergent views amongst rheumatologist and the orthopaedic surgeon as regards indications, timing and effectiveness of rheumatoid joint surgery. This is to the detriment of the patient's best interest. Therefore, it is imperative that a multidisciplinary team approach be adopted towards managing each patient. The need of the hour is evolution of integrated Rheumatology Team comprising of rheumatologist, orthopaedic surgeon, pain care specialist, physiotherapist and nurse, a close synergy of interests to provide holistic care to patients of inflammatory joint disorders.     

Marr and Reductionism

David Marr's three-level method for completely understanding a cognitive system and the importance he attaches to the computational level are so familiar as to scarcely need repeating. Fewer seem to recognize that Marr defends his famous method by criticizing the “reductionistic approach.” This sets up a more interesting relationship between Marr and reductionism than is usually acknowledged. I argue that Marr was correct in his criticism of the reductionists of his time—they were only describing (cellular activity), not explaining (cognitive functions). But a careful metascientific account of reductionistic neuroscience over the past two decades reveals that Marr's criticisms no longer have force. Contemporary neuroscience now explains cognition directly, although in a fashion—causal-mechanistically—quite different than Marr recommended. So while Marr was correct to reject the reductionism of his day and offer an alternative method for genuinely explaining cognition, contemporary cognitive scientists now owe us a new defense of Marr's famous method and the advantages of its explanations over the type now pursued successfully in current reductionist neuroscience. There are familiar reasons for thinking that this debt will not be paid easily.