Supine arm cycling during the post-flap recovery period for persons with spinal cord injuries: The multi-purpose arm cycle ergometer (M-PACE) safety and pilot testing

Objective:To describe how using a supine arm cycle ergometer can safely reduce deconditioning experienced by patients with spinal cord injury or disorder (SCI/D) during their four to six weeks of complete bed rest after surgery to close a stage 4 pressure injury.Design:This pilot project used a newly designed arm cycle ergometer (known as the M-PACE) that extends over the bed, allowing a patient to lie completely supine while exercising.Setting:The M-PACE was designed and built at the Minneapolis Veterans Affairs Health Care System (MVAHCS) and pilot tested at the MVAHCS SCI/D Center.Participants:Patients with SCI/D, recovering from flap surgery and deemed appropriate to use the arm cycle ergometer were enrolled in the pilot study (n = 47).Outcome Measures:A pre–post six-minute arm test (6MAT), a proxy for conditioning, was conducted on a subset (n = 15) of participants before and after the supine cycling exercise training program. Participants’ rating of perceived exertion (RPE) scores were collected at cessation of each 6MAT. Participants gave feedback on their perception of using the M-PACE.Results/Conclusions:The 6MAT RPE was significantly reduced after training with the M-PACE while on bed rest (P = 0.003). Also, significantly more rotations were performed after completing the training program (P = 0.02). Further, study participants who accessed the M-PACE found using it helped offset the tedium of laying supine during flap surgery recovery. The differences in the 6MAT pre- to post measures indicate the M-PACE should be further studied for offsetting the normal deconditioning that occurs with extended bedrest.     

Music enjoyment with cochlear implantation

Since the advent of cochlear implant (CI) surgery in the 1960s, there have been remarkable technological and surgical advances enabling excellent speech perception in quiet with many CI users able to use the telephone. However, many CI users struggle with music perception, particularly with the pitch-based and melodic elements of music. Yet remarkably, despite poor music perception, many CI users enjoy listening to music based on self-report questionnaires, and prospective studies have suggested a disassociation between music perception and enjoyment. Music enjoyment is arguably a more functional measure of one’s listening experience, and thus enhancing one’s listening experience is a worthy goal. Recent studies have shown that re-engineering music to reduce its complexity may enhance enjoyment in CI users and also delineate differences in musical preferences from normal hearing listeners.     

Die Beeinflußbarkeit der Sensibilität an symmetrischen Hautgebieten bei einseitiger Hirnschädigung und bei Gesunden

Zusammenfassung Es wurden bei Hemiplegikern Sensibilitätsuntersuchungen mit Reizhaaren für den Drucksinn (v. Frey) auf beiden Körperseiten durchgeführt, dabei auf die Verteilung und den Grad der Störung geachtet; der Anstieg der Schwelle bei fortgesetzter Reizsetzung in einem Punkte (Schwellenlabilität) festgestellt, außerdem die Beeinflußbarkeit symmetrischer Hautstellen durch vorherige Reizung der Gegenseite.Es wurde festgestellt, daß gleichsinnige Störungen sowohl auf der herdgekreuzten als auch auf der herdgleichen Seite vorkommen, und damit das Ergebnis von Bychowsky und Eidinow bestätigt. Die Verteilung der Störung entspricht in einigen Fällen der in früheren Untersuchungen (Goldstein usw.) festgestellten Form der zunehmenden Hypästhesie an den distalen Teilen der Extremitäten und der verschiedenen Schwelle in lateralen und medialen Anteilen. Es war ferner möglich, sowohl an den unter-suchten Hemiplegikern wie an Gesunden durch wiederholte Reizsetzung an einer Hautstelle die Sensibilität der dazu symmetrischen Stelle im Sinne einer Herabsetzung der Schwelle bzw. eines Verschwindens der Schwellenlabilität zu beeinflussen. Diese Fest-stellung legt die Annahme nahe, daß ebenso wie durch Oberflächen-reizung die Schwelle an symmetrischer Stelle herabgesetzt wird, eine bestehende Hypästhesie die Gegenseite im Sinne einer Erhöhung der Schwelle beeinflußt. Die vorliegenden Untersuchungsergebnisse werden in Zusammenhang mit Umstimmungsvor-gängen, die von anderen Autoren an symmetrischen Hautbezirken wie auch auf motorischem Gebiet an symmetrischen Muskelgebieten gefunden wurden, betrachtet.Diese Arbeit wurde der Medizin. Fakultät der Universität Freiburg als Dissertation zur Erlangung der Doktorwürde vorgelegt.     

Mikroskopische Untersuchungen der intramuralen Magennerven beim Pylorospasmus

Ohne ZusammenfassungMit 5 Textabbildungen.     

Trends in epidemiology and primary treatment of anal squamous cell carcinoma in the Netherlands (1990–2021)

A rapid increase in the incidence of anal squamous cell carcinoma (SCC) was reported in several countries over the past decades. This study assessed trends in epidemiology and primary treatment over a 32-year period (1990–2021) using the Netherlands Cancer Registry. The study population included 4273 patients, 44.2% male and 55.8% female (median age 63 years). The age-standardised incidence rate (European Standardised Rate, ESR) increased from 0.5 to 1.6 per 100,000, which entailed an average annual percentage change (AAPC) of 5.0% (95% confidence interval [CI]: 4.5%–5.8%). While incidence among females increased continuously over the total period (AAPC 4.9%; 95%CI: 4.4%–5.6%), to 1.8 per 100,000 ESR in 2021, incidence among males increased until 2016 (annual percentage change [APC] of 6.3%; 95%CI: 5.6%–10.7%), after which it seemed to stabilise (APC −2.1%; 95%CI: −16.8%–4.5%). Significant trends were also observed in distribution of age, tumour stage and primary treatment modalities. Five-year relative survival (RS) was estimated using the Pohar–Perme estimator, and this improved from 56.1% in 1990–1997 (95%CI: 49.3%–62.4%) to 67.9% in 2014–2021 (95%CI: 64.7%–70.9%), but remained poor for stage IV disease. Evaluation through a multivariable Poisson regression model demonstrated diagnosis in the most recent period to be independently associated with better RS, i n addition to female sex, younger age, early disease stage and any treatment. In conclusion, the rising incidence of anal SCC seems to decline in males, but not in females, and advances in diagnostics and therapeutic management have likely contributed to improved prognosis.