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Background: Postoperative hypocalcemia in laryngectomy patients can occur when part or whole of the thyroid gland has been removed. Preservation of the parathyroid glands in situ is considered one of the initial measures to prevent postoperative hypocalcemia even if all thyroid gland is removed. Our study aims to assess the efficacy of parathyroid gland preservation in situ to prevent postoperative hypocalcemia in cases where total laryngectomy is done with total thyroidectomy. Methods: The study included all laryngectomy patients done during a period from April 2020 to May 2021. Parathyroid gland preservation was done in both primary (12 cases) and salvage (16 cases). Both PTH and corrected calcium level were measured at different time points and used as a guide for further replacement. Results: We studied the association between outcome including recovery from transient hypocalcemia and certain variables like age, type of surgery, stage of tumor, and extent of neck dissection. Regarding type of surgery, all patients that underwent primary laryngectomy were totally recovered (n = 12, 100%); however, salvage cases were partially recovered (n = 10, 62.5%). Conclusion: Parathyroid preservation is achievable in cases of salvage laryngectomy in addition to primary laryngectomy with total thyroidectomy. Early monitoring of the patients PTH and Ca during their hospital stay is a good indicator of successful preservation. Long-term follow-up is advised for potential recovery from transient hypoparathyroidism. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems are shifting toward "patient-centered" care often without assessing the values important to patients. Analogously, the interests of the patient may be disparate with physician interests, as pay-for-performance models become common. The purpose of the study was to determine which medical preferences are essential for patients during their surgical care. Methods: This prospective, observational study surveyed 102 patients who had undergone a primary knee replacement and/or hip replacement surgery about hypothetical scenarios regarding their surgical experience. Data analysis included categorical variables presented as a number and percent, while continuous variables presented as mean and standard deviation. Statistical analysis for anticoagulation data included the Pearson chi-square test and one-way ANOVA test. Results: A large majority, 73 patients (72%), would not pay to have a four-centimeter or smaller incision. The remaining 29 patients (28%) would prefer to have a four-centimeter or smaller incision and would pay a mean of $1,328 ± 1,629 for that day. A significant number of patients preferred not to use anticoagulation (p = 0.019); however, the value attributed to avoiding a specific method of anticoagulation was found not to be significant (p = 0.507). Conclusions: The study determined the metrics prioritized by hospitals and surgeons are not important to the majority of patients when they evaluate their own care. These disconnects in the entitlements patients expect and receive can be solved by including patients in discussions with physicians and hospital systems. [ABSTRACT FROM AUTHOR]

Purpose. Skeletal muscle mass (SMM) is an important biomarker for health in older cancer patients. However, there is limited information on the recovery course of SMM after esophagectomy in older patients. This study aimed to investigate the recovery course of SMM after esophagectomy and the predictors in older cancer patients. Methods. We conducted a single-center, retrospective cohort study. Esophageal cancer patients who underwent esophagectomy were included. The skeletal muscle mass index (SMI) was calculated using computed tomography images. The loss of SMI at 4 and 12 months after surgery was calculated as [(preoperative − postoperative SMI) ÷ preoperative SMI] × 100%. Nonrecovery was defined as an SMI loss of ≥2% at 12 months after surgery, considering physiological loss with aging. One-way analysis of variance and multivariate logistic regression analysis was used for statistical analysis. Results. A total of 105 older (≥70 years) and 156 nonolder (<70 years) patients were analyzed. Older patients had a significantly larger loss of SMI 4 months (mean: 5.7% vs. 3.1%; p = 0.021) and 12 months (mean: 1.0% vs. −1.4%; p = 0.040) after surgery than nonolder patients. In older patients, the number of patients with nonrecovery of SMI at 12 months after surgery was 55 (52%). In older patients, significant predictors for the nonrecovery of SMI were preoperative sarcopenia (adjusted OR: 0.297; p = 0.012), neoadjuvant chemotherapy (adjusted OR: 0.248; p = 0.015), and loss of SMI 4 months after surgery (per 1%; adjusted OR: 1.076; p = 0.018). Conclusions. It is suggested that older esophageal cancer patients have a larger unmet need for long-term postoperative loss of SMM than nonolder patients. Continuous outpatient rehabilitation, including exercise and nutritional therapy after discharge, which targets improvement in SMM at 4 months, may improve SMI at 12 months after surgery in older esophageal cancer patients. [ABSTRACT FROM AUTHOR]

Background Intense physical activity can result in exercise-induced muscle damage, delayed-onset muscle soreness, and decrements in performance. Phototherapy (PhT), sometimes referred to as photobiomodulation or low-level laser therapy, may enhance recovery from vigorous exercise. Purpose The purpose of this study was to assess the influence of phototherapy on functional movements (vertical jump, agility), and perceptions of muscle soreness following exercise-induced muscle damage caused by high volume sprinting and decelerations. Methods In a between-group design, 33 participants performed 40x15m sprints, a protocol intended to cause muscle damage. Immediately following sprinting and in the four days following, vertical jump and agility were assessed, as well as calf, hamstring, quadriceps, and overall perceptions of soreness. Sixteen subjects (age 20.6±1.6 yrs; BMI 25.8±4.6 kg.m-2) received PhT prior to testing each day, while 17 (age 20.8±1.3 yrs; BMI 26.2±4.5 kg.m-2) received sham PhT and served as a control (CON). Measurements were recorded during five days of recovery from the repeated sprint protocol, then compared to those recorded during three baseline days of familiarization. Area under the curve was calculated by summing all five scores, and comparing those values by condition via a two-tailed unpaired t-test for normally distributed data, and a two-tailed Mann-Whitney U test for nonparametric data (alpha level = 0.05). Results Calf soreness was lower in PhT compared to CON (p = 0.02), but no other significant differences were observed between groups for vertical jump, agility, quadriceps, hamstring, and overall soreness (p > 0.05). Discussion Phototherapy may attenuate soreness in some muscle groups following exercise-induced muscle damage, but may not enhance recovery after explosive, short-duration activities. Conclusion Phototherapy may not be a useful recovery tool for those participating in explosive, short-duration activities. [ABSTRACT FROM AUTHOR]

Background: During open-door laminoplasty, the position of the bone gutter is not fixed, and when the gutter migrates inward, the outer end of the titanium plate must be fixed on the lamina edge. It is unclear whether this will affect the clinical efficacy. This study aimed to observe the influence of the titanium plate fixation position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy (CSM). Methods: A total of 98 patients with CSM who underwent open-door laminoplasty from August 2016 to October 2019 were included in this retrospective study. Fifty-five patients had the titanium plate fixed on the lateral mass (lateral mass group), and 43 patients had the titanium plate fixed on the lamina edge (lamina group). The opening angle, opening width, occurrence of hinge fracture, spinal cord drift distance, cervical curvature index (CCI), neurological function recovery (JOA score), neck function (NDI), C5 palsy and severity of axial symptoms were observed and compared between the two groups. Results: The opening angle in the lamina group was significantly larger than that in the lateral mass group, while the opening width and the spinal cord drift distance were significantly smaller than those in the lateral mass group (P < 0.05). The occurrence of hinge fracture in the lamina group was significantly higher than that in the lateral group (25.6% and 9.1%, respectively) (P < 0.05). The CCI was maintained well in both groups (P > 0.05), and there was no significant difference between the groups (P > 0.05). After surgery, the JOA score significantly increased in both groups (P < 0.05), and the neurological recovery rates were similar between the two groups (62.6% vs. 64.5%). The NDI score significantly decreased in both groups (P < 0.05), but the lateral mass group recovered to a greater degree than the lamina group (P < 0.05). The occurrence of C5 palsy was 2.3% in the lamina group and 14.5% in the lateral mass group, and there was a significant difference between the groups (P < 0.05). Postoperative axial symptom severity was significantly worse in the lamina group than in the lateral mass group (P < 0.05). Conclusions: In open-door laminoplasty, it is feasible to fix the titanium plate on the lateral mass or to the lamina due to the same neurological function recovery. However, fixing it to the lamina will increase the opening angle and decrease the opening width, making the hinge prone to fracture and increasing the severity of postoperative axial symptoms. [ABSTRACT FROM AUTHOR]

Background Digital therapeutic tools (e.g. mobile applications) can be accessible, low-cost interventions that counter misconceptions about medication assisted treatment (MAT) and/or improve deficits in MAT knowledge that are common barriers to treatment entry among individuals with opioid dependence. The purpose of this pilot study was to examine the preliminary effectiveness of a mobile application, 'uMAT-R', that includes health information about OUD recovery supported by science and MAT benefits. Methods Twenty-six adult participants with OUD recruited via social media completed all modules and pre/post-assessments within uMAT-R. McNemar's test was used to compare interest in treatment before and after completing the app, and paired t tests were used to compare MAT attitude scores before and after completing the modules within uMAT-R. Results Before viewing uMAT-R, 32% agreed/strongly agreed that they were interested in starting treatment to recover from opioid misuse, compared to 48% after completing uMAT-R. The average scores on the MAT attitudes scale and its Aid to Behavior Change subscale improved from before to after viewing uMAT-R. Among the participants, 88% felt that uMAT-R would be useful to consult when making decisions about recovery. Conclusions Our encouraging pilot findings support the use of uMAT-R to help address the current opioid epidemic. [ABSTRACT FROM AUTHOR]

Background: We compared the effects of thoracic epidural analgesia (TEA) to conventional patient‐controlled analgesia (PCA) on several postoperative parameters of recovery after elective video‐assisted thoracoscopic (VATS) lobectomy. Methods: Ninety‐eight patients undergoing elective VATS lobectomy were enrolled. The primary endpoint was pain score. Recovery of bowel function, length of stay in the postanesthesia care unit (PACU), duration of postoperative hospital stay, and complications were assessed. Continuous variables were expressed and compared between groups using either a two‐tailed Student's t or Mann‐Whitney U test. Recovery of bowel function was compared using the log‐rank test. Results: Baseline characteristics between the groups were similar. Dynamic pain scores on postoperative days (PODs) 0–2 were significantly lower in the TEA group, as were resting pain scores on PODs 1 and 2 (P < 0.05). The mean duration to first flatus (16 ± 0.7 vs. 26 ± 0.7 hours; P < 0.001) and the mean length of stay in the PACU (34 vs. 67 minutes; P = 0.027) were shorter in the TEA compared to the PCA group, respectively. The only difference in postoperative complications was regarding confusion (5 TEA vs. 18 PCA patients; P = 0.002). No difference in overall length of stay was noted. Conclusions: Compared to PCA, TEA provided better postoperative pain control after VATS lobectomy and facilitated postoperative recovery of bowel function without increasing the length of hospital stay. This beneficial effect of TEA might be attributed to the attenuation of sympathetic hyperactivation, improved analgesia, and reduced opioid use. [ABSTRACT FROM AUTHOR]

Background: The aims of the present study were to investigate the factors affecting one-leg standing (OLS) time in patients with end-stage knee osteoarthritis (OA) and to clarify the age-related recovery process following total knee arthroplasty (TKA) in the early postoperative period. Methods: A total of 80 knees of 40 patients with knee OA were enrolled. They were asked to perform relaxed standing on one leg for as long as possible. First, OLS time was measured. Second, age, body mass index, knee flexion angle during (KFA) OLS, femorotibial angle (FTA) during OLS, and a visual analogue scale (VAS) for pain were evaluated. Multiple regression analysis was done to identify the factors affecting OLS time. In addition, the recovery process was compared between older and younger patients after TKA. Results: A larger KFA during OLS, older age, and larger FTA were significantly associated with shorter OLS time. After TKA, postoperative OLS time in older patients did not improve significantly by postoperative day 20, while the time in younger patients improved significantly from postoperative day 19. Conclusions: Even if subjective knee pain and KFA during OLS improved, longer rehabilitation was required to improve OLS time in older patients in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described.Questions/purposes: The purposes of this study were (1) to determine the 10-year survivorship and functional outcome after Bernese PAO in a single-surgeon series; (2) to review which patient, surgical, and radiographic factors might predict outcome after the procedure; and (3) to define the learning curve for target acetabular correction.Methods: The first 68 PAOs performed for symptomatic hip dysplasia were retrospectively evaluated. None have been lost to followup with followup less than 2 years. Endpoints for the lost to followup (n = 2) are at the time of when last seen. During the study period, the same surgeon performed 562 pelvic osteotomies (including Salter, Pemberton, Dega and Chiari) and 64 shelf acetabuloplasties. Bernese PAO was used only for symptomatic dysplasia (center-edge angle < 25° and nonhorizontal acetabular roof) in developmentally mature hips without evidence of major joint incongruence or subluxation. Most patients were female (n = 49 [60 hips, 88%]); mean age at operation was 25 years (SD 7). Sixteen hips had previous hip procedures. The study's mean followup was 8 years (range, 2-18 years). Patient-reported functional outcome was obtained using the WOMAC score (best-worst: 0-96). Radiographic parameters of dysplasia (acetabular index [AI], center-edge angle [CEA], congruency, Tönnis grade, and joint space) were evaluated from preoperative and postoperative radiographs using computer software.Results: The 10-year survival rate was 93% (95% confidence interval [CI], 82%-100%); four patients underwent further surgery to the hip in the study period. The mean WOMAC was 12 (range, 0-54). Factors that influenced survival included joint congruency (100% versus 78%; 95% CI, 61%-96%; p = 0.03) and acetabular orientation correction achieved (AIpostoperative < 15° [100% versus 65%; 95% CI, 43-88; p < 0.001] and CEApostoperative 20° to 40° [100% versus 71.9%; 52.8-100; p < 0.001]). Better WOMAC scores were seen if postoperative AI < 15° (7 versus 25, p = 0.005) and CEA between 20° and 40° (7 versus 23, p = 0.005) were achieved. The chances of obtaining acetabular correction within this range improved after the 20(th) procedure (30% versus 70%, p = 0.008).Conclusions: This study reports excellent results after Bernese PAO in the hands of an experienced pediatric hip surgeon. We advocate cautious correction of the acetabular fragment. Future studies should concentrate on how to determine what the optimal target is and how to achieve it intraoperatively, minimizing the learning curve associated with it.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: The utility of dairy ingredients in the supplementary foods used in the treatment of childhood moderate acute malnutrition (MAM) remains unsettled. Objective: We evaluated the effectiveness of a peanut-based ready-to-use supplementary food (RUSF) with soy protein compared with a novel RUSF containing dairy ingredients in the form of whey permeate and whey protein concentrate in the treatment of children with MAM. Design: We conducted a randomized, double-blind clinical effectiveness trial involving rural Malawian and Mozambican children 6-59 mo of age with MAM treated with either soy RUSF or a novel whey RUSF treatment of ~75 kcal ⋅ kg-1 ⋅ d-1 for up to 12 wk. Results: The proportion of children that recovered from MAM was significantly higher in the group that received whey RUSF (960 of 1144; 83.9%) than in the group that received soy RUSF (874 of 1086; 80.5%; P, 0.04; risk difference 3.4%, 95% CI: 0.3%, 6.6%). Children who consumed whey RUSF also demonstrated better growth markers, with a higher mean midupper arm circumference (MUAC) at the time of discharge (P < 0.009), greater MUAC gain during the course of treatment (P < 0.003), higher mean weight-for-height z score at discharge (P < 0.008), and greater weight gain (P < 0.05). No significant differences were identified in length gain or time to recovery between the 2 groups. Conclusion: This study highlights the importance of milk protein in the treatment of MAM, because the use of a novel whey RUSF resulted in higher recovery rates and improved growth than did soy RUSF, although the whey RUSF supplement provided less total protein and energy than the soy RUSF. This study was registered at clinicaltrials.gov as NCT01790048. [ABSTRACT FROM AUTHOR]

Although playing a crucial role for the prevention of long-term health impairment, interventions aiming at the improvement of employees' recovery processes are still scarce. In this study, we therefore investigated the effectiveness of a low-dose mindfulness intervention for recovery from work. In addition, differential responding to the treatment in terms of treatment-by-baseline interactions was studied. A sample of 140 employees participated in a randomized field experiment with a self-training and a wait-list control group. Three central recovery processes (psychological detachment, sleep quality, and sleep duration) were assessed with event-sampling methodology involving daily measurements over 10 workdays. Growth curve analyses revealed intervention effects on sleep quality and sleep duration. No effects were found for psychological detachment after work and for the proposed treatment-by-baseline interactions. Our findings are discussed in the context of occupational health promotion in general and mindfulness-based interventions in specific. Practitioner points Although daily recovery from the demands of work has been shown to be vital for employee well-being and performance, research on how workplace interventions can help improve recovery is still scarce., This study investigated the effectiveness of a brief, economic mindfulness intervention on processes that are vital for recovery - psychological detachment, sleep quality, and sleep duration., Findings revealed positive effects of the intervention on sleep quality and duration, but not on psychological detachment. [ABSTRACT FROM AUTHOR]

Question: In the 6 months after total knee arthroplasty (TKA), what is the pattern of pain resolution and functional recovery in people without diabetes, with diabetes that does not impact on routine activities, and with diabetes that does impact on routine activities? Is diabetes that impacts on routine activities an independent predictor of slower resolution of pain and functional recovery after TKA? Design: Community-based prospective observational study. Participants: A consecutive cohort of 405 people undergoing primary TKA, of whom 60 (15%) had diabetes. Participants with diabetes were also asked preoperatively whether diabetes impacted on their routine activities. Participants were categorised into three groups: no diabetes (n = 345), diabetes with no impact on activities (n = 41), and diabetes that impacted activities (n = 19). Outcome measures: Pain and function were measured using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index within the month before surgery and 1, 3 and 6 months after surgery. Demographic, medical and surgical factors were also measured, along with depression, social support and health-related quality of life. Results: No baseline differences in pain and function were seen among the three groups ( p > 0.05). Adjusting for age, gender and contralateral joint involvement across the 6 postoperative months, participants with diabetes that impacted on routine activities had pain scores that were 8.3 points higher (indicating greater pain) and function scores that were 5.4 points higher (indicating lower function) than participants without diabetes. Participants with diabetes that doesn’t impact on routine activities had similar recovery to those without diabetes. Conclusion: People undergoing TKA who report preoperatively that diabetes impacts on their routine activities have less recovery over 6 months than those without diabetes or those with diabetes that does not impact on routine activities. Physiotherapists could institute closer monitoring within the hospital and community settings for people undergoing TKA who perceive that diabetes impacts on their routine activities. [Amusat N, Beaupre L, Jhangri GS, Pohar SL, Simpson S, Warren S, Jones CA (2014) Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study. Journal of Physiotherapy 60: 217–223] [ABSTRACT FROM AUTHOR]

Background: Recent frameworks for understanding food rewards recognize the role of separable affective and motivational processes (liking and wanting) in driving human eating behavior. Separate assessments of liking and wanting may aid in understanding the complex eating-related behaviors seen in anorexia nervosa (AN). Objective: The aim of this study was to examine separately liking and wanting for foods of different energy densities in women at different stages of AN and in healthy volunteers at both an implicit and an explicit level. Design: Explicit liking and wanting responses to high- and low-calorie foods were derived from analog ratings, whereas an implicit "wanting" measure was identified by using reaction time in a forced-choice procedure. Explicit and implicit processes were compared across 3 groups of AN participants (current AN, weight-restored AN, and recovered AN) and healthy volunteers. Results: Currently underweight AN participants explicitly wanted high-calorie foods less than did the other groups. Both current and weight-restored AN groups demonstrated significantly less implicit "wanting" for high-calorie foods and more implicit "wanting" for low-calorie foods--an inverted pattern to never-ill participants. Conclusions: The aberrant responses to food that characterize AN may be driven more by altered motivational salience ("wanting") than by explicit liking responses. This pattern of aberrant food reward appears to be independent of weight status. Examining the processes that motivate approach or avoidance of low- and high-calorie foods in AN may aid the development of targeted strategies to augment existing interventions. [ABSTRACT FROM AUTHOR]

Background: Moderate and severe acute malnutrition affects 13% of children <5 y of age worldwide. Severe acute malnutrition affects fewer children but is associated with higher rates of mortality and morbidity. Supplementary feeding programs aim to treat moderate acute malnutrition and prevent the deterioration to severe acute malnutrition. Objective: The aim was to compare recovery rates of children with moderate acute malnutrition in supplementary feeding programs by using the newly recommended ration of ready-to-use supplementary food (RUSF) and the more conventional ration of corn-soya blend (CSB) in Ethiopia. Design: A total of 1125 children aged 6-60 mo with moderate acute malnutrition received 16 wk of CSB or RUSF. Children were randomly assigned to receive one or the other food. The daily rations were purposely based on the conventional treatment rations distributed at the time of the study in Ethiopia: 300 g CSB and 32 g vegetable oil in the control group (1413 kcal) and 92 g RUSF in the intervention group (500 kcal). The higher ration size of CSB was provided because of expected food sharing. Results: The HR for children in the CSB group was 0.85 (95% CI: 0.73, 0.99), which indicated that they had 15% lower recovery (P = 0.039). Recovery rates of children at the end ofthe 16-wk treatment period trended higher in the RUSF group (73%) than in the CSB group (67%) (P = 0.056). Conclusion: In comparison with CSB, the treatment of moderate acute malnutrition with RUSF resulted in higher recovery rates in children, despite the large ration size and higher energy content of the conventional CSB ration. This trial was registered at www.clinicaltrials.gov as NCT 01097889. [ABSTRACT FROM AUTHOR]

Socio-economic class affects a variety of health outcomes -- this includes the experience of pain. Little work, however, explores how class affects pain experiences of college student-athletes. This gap is notable given injuries frequently occur in this population. We argue that lower class student-athletes will ironically be more likely to experience pain but less likely to report it. We find evidence for this claim with a large survey of student-athletes from a major National College Athletic Association conference. We further present evidence that class may influence pain reporting via identity, experiential, and social pathways. Our results highlight how potentially vulnerable student-athletes may "play with pain." The findings also suggest that practitioners should pay particular attention to self-reports of pain by lower class student-athletes. [ABSTRACT FROM AUTHOR]