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Matthies L, Amir-Kabirian H, Gebrekidan MT, Braeuer AS, Speth US, Smeets R, Hagel C, Gosau M, Knipfer C, Friedrich RE. Raman difference spectroscopy and U-Net convolutional neural network for molecular analysis of cutaneous neurofibroma. PLoS One 2024; 19:e0302017. [PMID: 38603731 PMCID: PMC11008861 DOI: 10.1371/journal.pone.0302017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
In Neurofibromatosis type 1 (NF1), peripheral nerve sheaths tumors are common, with cutaneous neurofibromas resulting in significant aesthetic, painful and functional problems requiring surgical removal. To date, determination of adequate surgical resection margins-complete tumor removal while attempting to preserve viable tissue-remains largely subjective. Thus, residual tumor extension beyond surgical margins or recurrence of the disease may frequently be observed. Here, we introduce Shifted-Excitation Raman Spectroscopy in combination with deep neural networks for the future perspective of objective, real-time diagnosis, and guided surgical ablation. The obtained results are validated through established histological methods. In this study, we evaluated the discrimination between cutaneous neurofibroma (n = 9) and adjacent physiological tissues (n = 25) in 34 surgical pathological specimens ex vivo at a total of 82 distinct measurement loci. Based on a convolutional neural network (U-Net), the mean raw Raman spectra (n = 8,200) were processed and refined, and afterwards the spectral peaks were assigned to their respective molecular origin. Principal component and linear discriminant analysis was used to discriminate cutaneous neurofibromas from physiological tissues with a sensitivity of 100%, specificity of 97.3%, and overall classification accuracy of 97.6%. The results enable the presented optical, non-invasive technique in combination with artificial intelligence as a promising candidate to ameliorate both, diagnosis and treatment of patients affected by cutaneous neurofibroma and NF1.
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Affiliation(s)
- Levi Matthies
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik Amir-Kabirian
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Medhanie T. Gebrekidan
- Institute of Thermal-, Environmental- and Resources‘ Process Engineering, Technische Universität Bergakademie Freiberg, Freiberg, Germany
| | - Andreas S. Braeuer
- Institute of Thermal-, Environmental- and Resources‘ Process Engineering, Technische Universität Bergakademie Freiberg, Freiberg, Germany
| | - Ulrike S. Speth
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Division of “Regenerative Orofacial Medicine”, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Knipfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E. Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Finkelstein ER, Hui-Chou H, Fullerton N, Jose J. Experience with ultrasound neurography for postoperative evaluation of targeted muscle reinnervation. Skeletal Radiol 2024; 53:811-816. [PMID: 37665347 DOI: 10.1007/s00256-023-04441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/09/2023] [Accepted: 08/26/2023] [Indexed: 09/05/2023]
Abstract
Targeted muscle reinnervation (TMR) was originally developed as a means for increasing intuitive prosthesis control, though later found to play a role in phantom limb pain and neuroma prevention. There is a paucity of literature describing the clinical course of patients with poor TMR surgical outcomes and the value of imaging in the postoperative recovery period. This report will illustrate the potential utility of ultrasound neurography to accurately differentiate TMR surgical outcomes in two patients that received upper extremity amputation and subsequent reconstruction with TMR. Ultrasound evaluation of TMR sites in patient 1 confirmed successful reinnervation, evident by nerve fascicle continuity and eventual integration of the transferred nerve into the target muscle. Conversely, the ultrasound of patient 2 showed discontinuity of the nerve fascicles, neuroma formation, and muscle atrophy in all three sites of nerve transfer, suggesting an unsuccessful procedure and poor functional recovery. Ultrasound neurography is uniquely able to capture the longitudinal trajectory of rerouted nerves to confirm continuity and eventual reinnervation into muscle. Therefore, the application of ultrasound in a postoperative setting can correctly identify instances of failed TMR before this information would become available through clinical evaluation. Early identification of poor TMR outcomes may benefit future patients by fostering the discovery of failure mechanisms and aiding in further surgical planning to improve functional outcomes.
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Affiliation(s)
- Emily R Finkelstein
- Dewitt Daughtry Family Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
- Division of Plastic Surgery, University of Miami Hospital, 1400 NW 12Th Ave, Miami, FL, 33136, USA.
| | - Helen Hui-Chou
- Department of Orthopedic Surgery, Divison of Hand, Peripheral Nervem and Upper Extremity Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Natalia Fullerton
- Dewitt Daughtry Family Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jean Jose
- Department of Clinical Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
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Abd-Elsayed A, Henjum LJ, Shiferaw BT, Yassa PE, Fiala KJ. Infrapatellar Branch of the Saphenous Nerve: Therapeutic Approaches to Chronic Knee Pain. Curr Pain Headache Rep 2024; 28:279-294. [PMID: 38294640 DOI: 10.1007/s11916-024-01217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW The infrapatellar branch of the saphenous nerve (IPS) is an under-investigated nerve that can be a source of chronic knee pain. This literature review aims to deliver an up-to-date review of chronic pain transmitted via the IPS along with therapeutic approaches available for pain refractory to conservative measures. RECENT FINDINGS Knee pain transmitted via the IPS can arise from several etiologies. Damage to the IPS is often iatrogenic and develops following total knee arthroplasty, anterior cruciate ligament reconstruction, and other knee surgical procedures. Other causes of IPS-derived pain include entrapment of the nerve, neuromas, Schwannomas, and pain from knee osteoarthritis transmitted through the IPS.This article investigated therapeutic approaches to pain derived from the IPS. Common approaches included radiofrequency ablation, neuroma excisions, Schwannoma excision, nerve blocks, surgical exploration, surgical release of an entrapped nerve, cryoablation, and peripheral nerve stimulation. Pain scores, duration of pain relief, adverse events, and secondary outcomes were all included in this review. A subset of the patient population experiences chronic pain deriving from the IPS that is refractory to conservative treatment measures. This review aims to evaluate the etiologies and therapeutic approaches for chronic pain arising from the IPS refractory to conservative treatments.
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Affiliation(s)
- Alaa Abd-Elsayed
- Anesthesiology Department, University of Wisconsin, 600 Highland Avenue, Madison, WI, B6/319 CSC, USA.
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Richey P, Funk M, Sakamoto F, Plotkin S, Ly I, Jordan J, Muzikansky A, Roberts J, Farinelli W, Levin Y, Garibyan L, Blakeley JO, Anderson RR. Noninvasive treatment of cutaneous neurofibromas (cNFs): Results of a randomized prospective, direct comparison of four methods. J Am Acad Dermatol 2024; 90:767-774. [PMID: 38086517 DOI: 10.1016/j.jaad.2023.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/20/2023] [Accepted: 11/13/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND People with Neurofibromatosis Type 1 (NF1) suffer disfigurement and pain when hundreds to thousands of cutaneous neurofibromas (cNFs) appear and grow throughout life. Surgical removal of cNFs under anesthesia is the only standard therapy, leaving surgical scars. OBJECTIVE Effective, minimally-invasive, safe, rapid, tolerable treatment(s) of small cNFs that may prevent tumor progression. METHODS Safety, tolerability, and efficacy of 4 different treatments were compared in 309, 2-4 mm cNFs across 19 adults with Fitzpatrick skin types (FST) I-IV: radiofrequency (RF) needle coagulation, 755 nm alexandrite laser with suction, 980 nm diode laser, and intratumoral injection of 10 mg/mL deoxycholate. Regional pain, clinical responses, tumor height and volume (by 3D photography) were assessed before, 3 and 6 months post-treatment. Biopsies were obtained electively at 3 months. RESULTS There was no scarring or adverse events > grade 2. Each modality significantly (P < .05) reduced or cleared cNFs, with large variation between tumors and participants. Alexandrite laser and deoxycholate were fast and least painful; 980 nm laser was most painful. Growth of cNFs was not stimulated by treatment(s) based on height and volume values at 3 and 6 months compared to baseline. LIMITATIONS Intervention was a single treatment session; dosimetry has not been optimized. CONCLUSIONS Small cNFs can be rapidly and safely treated without surgery.
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Affiliation(s)
- Patricia Richey
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts.
| | - Margaret Funk
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Fernanda Sakamoto
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Scott Plotkin
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ina Ly
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Justin Jordan
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Josh Roberts
- Department of Neurology, Johns Hopkins, Baltimore, Maryland
| | - William Farinelli
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Yakir Levin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Lilit Garibyan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | | | - R Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
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Khadanovich A, Benes M, Kaiser R, Herma T, Kachlik D. Clinical anatomy of the lateral antebrachial cutaneous nerve: Is there any safe zone for interventional approach? Ann Anat 2024; 252:152202. [PMID: 38128746 DOI: 10.1016/j.aanat.2023.152202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The lateral antebrachial cutaneous nerve (LACN) is a somatosensory nerve coursing in the lateral portion of the forearm. The nerve is located in a close proximity to the cephalic vein (CV) all along its course with a danger of being injured during venipuncture. The LACN also overlaps and communicates with the superficial branch of the radial nerve (SBRN) in the distal forearm and hand, making the awareness of their relationship of great importance in the treatment of neuroma. The aim of the study was to observe the relationship of the LACN to surrounding structures as well as its branching pattern and distribution. MATERIALS AND METHODS Ninety-three cadaveric forearms embalmed in formaldehyde were dissected. The relationship of the LACN to surrounding structures was noted and photographed, and distances between the structures were measured with a digital caliper. The cross-sectional relationships of the LACN and SBRN to the CV were described using heatmaps. RESULTS The emerging point of the LACN was found distally, proximally or at the level of the interepicondylar line (IEL). The LACN branched in 76 cases (81.7 %) into an anterior and posterior branch at mean distance of 47.8 ± 34.2 mm distal to the IEL. The sensory distribution was described according to the relationship of the LACN branches to the medial border of the brachioradialis muscle. The LACN supplying the dorsum of the hand was observed in 39.8 % of cases. The LACN and the SBRN intersected in 86 % of upper limbs with communications noticed in 71 % of forearms. The LACN was stated as the most frequent donor of the communicating branch resulting in neuroma located distal to the communication and being fed from the LACN. The relationship of the LACN and the CV showed that the IEL is the most appropriate place for the venipuncture due to maximal calibers of the CV and deep position of the LACN. The LACN was adjacent to the cubital perforating vein and the radial artery in all cases. The medial border of the brachioradialis muscle was observed less than 1.8 mm from the LACN. CONCLUSION The study provides morphological data on the LACN distribution, branching pattern and relationship to surrounding structures in a context of clinical use in different spheres of medicine. The branching pattern of the LACN appears to be more constant compared to data provided by previous authors. We emphasized the meaning of cross-sectional relationship of the LACN to the CV to avoid venipuncture outside the cubital fossa if possible. The posterior branch of the LACN was predicted as appropriate donor of the graft for a digital nerve. The LACN appeared to be in a close proximity within the whole length of the brachioradialis muscle what the orthopedic surgeons must be concerned of. The meaning of the donor-nerve of the communicating branch in neuroma treatment was also introduced.
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Affiliation(s)
- Anhelina Khadanovich
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Benes
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radek Kaiser
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic; First Faculty of Medicine, Charles University, Prague, Czech Republic; Spinal Surgery Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tomas Herma
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Makeľ M, Němcová V, Hora A, Whitley A, Kulvajtová M, Sukop A, Kaiser R. Anterior transposition of the radial nerve to achieve primary suture for its reconstruction: Anatomical feasibility study. J Plast Reconstr Aesthet Surg 2024; 89:1-6. [PMID: 38118360 DOI: 10.1016/j.bjps.2023.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Radial nerve palsy after humeral shaft fractures is often associated with formation of a neuroma in continuity. The current standard of treatment is neuroma resection and nerve grafting with contentious results. Anterior transposition of the radial nerve may reduce the length of its path, allowing reconstruction by primary suture. The aim of this study was to determine the maximum length of radial nerve defect that can be treated by the anterior transposition to allow primary suture to be performed. METHODS We use 10 arms from five fresh cadavers. The radial nerve was dissected in the lateral inter-muscular septum and along the anterior aspect of the forearm. The radial nerve was transected at the level of the spiral groove and both stumps were than transposed anterior to the medial inter-muscular septum. The length of tension-free overlap that could be achieved was measured. RESULTS The average length of the overlap at zero degrees of elbow flexion was 10.00 ± 1.84 mm. Theoretically, this will allow a defect of 20 ± 3.69 mm SD to be treated by primary suture. CONCLUSION Our results suggest that anterior transposition can be used for radial nerve defects up to 2 cm; however, dissection of both stumps proved to be challenging.
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Affiliation(s)
- Michal Makeľ
- Department of Plastic Surgery, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic; Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Veronika Němcová
- Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Hora
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Whitley
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of General Surgery, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Markéta Kulvajtová
- Department of Forensic Medicine, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Andrej Sukop
- Department of Plastic Surgery, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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Levin LS. Letter to the Editor: Comment on Surgical Treatment of Symptomatic End- Neuroma With a New Bioresorbable Copolyester Nerve Capping Device-A Multicenter Prospective Cohort Study. Ann Plast Surg 2024; 92:137. [PMID: 38117052 DOI: 10.1097/sap.0000000000003791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
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Langeveld M, Bruin LL, Hundepool CA, Power D, Duraku LS, Zuidam JM. Anatomy of the Superficial Radial Nerve and Its Target Nerves for Targeted Muscle Reinnervation: An Anatomical Cadaver Study. Plast Reconstr Surg 2024; 153:95e-100e. [PMID: 37189238 DOI: 10.1097/prs.0000000000010690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Targeted muscle reinnervation (TMR) is a surgical procedure for treating symptomatic neuroma, in which the neuroma is removed and the proximal nerve stump is coapted to a donor motor branch innervating a nearby muscle. This study aimed to identify optimal motor targets for TMR of the superficial radial nerve (SRN). METHODS Seven cadaveric upper limbs were dissected to describe the course of the SRN in the forearm and motor nerve supply-number, length, diameter, and entry points in muscle of motor branches-for potential recipient muscles. RESULTS The radial nerve provided three (three of six) motor branches, two (two of six) motor branches, or one (one of six) motor branch to the brachioradialis muscle, entering the muscle 21.7 ± 17.9 to 10.8 ± 15 mm proximal to the lateral epicondyle. One (one of seven), two (three of seven), three (two of seven), or four (one of seven) motor branches innervated the extensor carpi radialis longus muscle, with entry points 13.9 ± 16.2 to 26.3 ± 14.9 mm distal from the lateral epicondyle. In all specimens, the posterior interosseous nerve gave off one motor branch to the extensor carpi radialis brevis, which divided into two or three secondary branches. The distal anterior interosseus nerve was assessed as a potential recipient for TMR coaptation and had a freely transferable length of 56.4 ± 12.7 mm. CONCLUSIONS When considering TMR for neuromas of the SRN in the distal third of the forearm and hand, the distal anterior interosseus nerve is a suitable donor target. For neuromas of the SRN in the proximal two-thirds of the forearm, the motor branches to the extensor carpi radialis longus, extensor carpi radialis brevis, and brachioradialis are potential donor targets.
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Affiliation(s)
- Mirte Langeveld
- From the Department of Plastic, Reconstructive Surgery, and Handsurgery, Erasmus Medical Center
| | - Luca L Bruin
- From the Department of Plastic, Reconstructive Surgery, and Handsurgery, Erasmus Medical Center
| | - Caroline A Hundepool
- From the Department of Plastic, Reconstructive Surgery, and Handsurgery, Erasmus Medical Center
| | - Dominic Power
- Hand and Peripheral Nerve Injury Service, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust
| | - Liron S Duraku
- Department of Plastic, Reconstructive Surgery, and Handsurgery, Amsterdam University Medical Center
| | - J Michiel Zuidam
- From the Department of Plastic, Reconstructive Surgery, and Handsurgery, Erasmus Medical Center
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Pp S, Sharma S. Comment on Surgical Treatment of Symptomatic End- Neuroma With a New Bioresorbable Copolyester Nerve Capping Device-A Multicenter Prospective Cohort Study. Ann Plast Surg 2024; 92:137. [PMID: 38117051 DOI: 10.1097/sap.0000000000003790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
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Elkholy AR, Rezk EM, Shabaan N, Elkhouly RM, Shamhoot EA. The role of preoperative ultrasound in the management of peripheral nerve injuries. Clin Neurol Neurosurg 2024; 236:108083. [PMID: 38104445 DOI: 10.1016/j.clineuro.2023.108083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Peripheral nerve injury refers to any damage or trauma to the nerves located outside the central nervous system. Ultrasonography is a reliable, cheap, and minimally invasive method in clinical practice to give physicians useful information about nerve injury. OBJECTIVES to assess the power of ultrasound in determining the presence, localization, and extent of neural damage in patients with clinical evidence of peripheral nerve lesions before surgery. METHODS This cross-sectional study was conducted on 78 patients (56 females and 22 males, aged from 9 to 52 years) who had different pathologies including entrapment, tumoral, post-traumatic, and post-surgical nerve injuries at the Neurosurgery and Physical Medicine, Rheumatology, and Rehabilitation Departments, Tanta University Hospitals. All studied patients had preoperative evaluation; neurological examination, electrodiagnostic studies, and sonographic examinations with linear array transducers (frequencies ranging from 7.5 to 16 MHz). RESULTS The most common pathological condition was entrapment neuropathy (39 patients) (50%). Ultrasound complemented the electrodiagnostic studies by determining the site of entrapment manifested by increased mean maximum cross-sectional area of the nerve proximal to the site of entrapment and nerve hypoechogenicity. In post-traumatic and iatrogenic neuropathies (35 patients) (44.9%), the ultrasound finding revealed neuroma in continuity in nine cases (11.5%), complete neurotmesis with stump neuroma in eighteen patients (23.1%), and eight cases (10.3%) showed perineural adhesion. In all cases, the nerve was hypoechoic at the site of injury. The presence of hyperechoic fibrous tissue could indicate perineural adhesion and the necessity for neurolysis. This study also included three (3.8%) cases had schwannoma, and one case (1.3%) had neurofibroma. Ultrasound was used to confirm the diagnosis by determining the tumor's size and vascular supply. CONCLUSIONS Ultrasonography is a diagnostic and surgical planning tool that is becoming more and more useful for the management of peripheral nerve injuries. Its high resolution and real-time capability provide safe and cost-effective scans that aid in determining the extent of injuries. For patients with peripheral nerve injuries, ultrasound is advised to be added to the routine clinical and neurophysiological evaluation. It is also advised to use ultrasound as a first-line imaging modality for tumors thought to be of nerve origin.
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Affiliation(s)
- Ahmed R Elkholy
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt
| | - Essam M Rezk
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt.
| | - Nehal Shabaan
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt
| | - Radwa M Elkhouly
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Egypt
| | - Ebrahim A Shamhoot
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt
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Finkelstein ER, Buitrago J, Jose J, Levi AD, Xu KY, Burks SS. Lower extremity peripheral nerve pathology: Utility of preoperative ultrasound-guided needle localization before operative intervention. Skeletal Radiol 2023; 52:1997-2002. [PMID: 37060462 DOI: 10.1007/s00256-023-04347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Historically, the use of ultrasound (US) in the management of peripheral nervous system (PNS) pathology has been limited to diagnostic confirmation or guidance for interventional injections. This technical case series will demonstrate the utility and versatility of preoperative US-guided needle localization for the excision of lower extremity neuromas and other pathology of the PNS. Five patients with symptomatic lower extremity PNS tumors were retrospectively reviewed. This case series corroborates the technical nuances of localizing lower extremity neuromas by US-guided needle and wire placement prior to operative excision. This was achieved by a multidisciplinary team that included plastic surgery, neurosurgery, and radiology. Five patients had US-guided needle localization of a lower extremity PNS target prior to operative intervention. Three patients had lower extremity neuromas of varying origins, including the lateral femoral cutaneous nerve (LFCN), saphenous nerve, and sural nerve. The remaining two patients had a sciatic nerve sheath Schwannoma and a femoral nerve glomus tumor. Under sonographic visualization, a needle was advanced to the target perimeter and withdrawn, leaving behind a percutaneous guidewire. This technique simplified the marking of the nerve course prior to dissection and led to efficient intraoperative identification of all five PNS tumors without any complications. Preoperative US-guided needle localization led to safe, accurate, and efficient perioperative and intraoperative identification of neuromas and other PNS tumors of the lower extremity prior to excision. By reducing the challenges of nerve identification in a scarred tissue bed, this multidisciplinary approach may decrease postoperative patient morbidity.
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Affiliation(s)
- Emily R Finkelstein
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA.
| | - Joanne Buitrago
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Jean Jose
- Department of Clinical Radiology, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Allan D Levi
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Kyle Y Xu
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - S Shelby Burks
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
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Deniel C, Guenoun D, Guillin R, Moraux A, Champsaur P, Le Corroller T. Anatomical study of the medial calcaneal nerve using high-resolution ultrasound. Eur Radiol 2023; 33:7330-7337. [PMID: 37209124 DOI: 10.1007/s00330-023-09699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/10/2023] [Accepted: 02/26/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To determine whether high-resolution ultrasound (US) can identify the course and relations of the medial calcaneal nerve (MCN). METHODS This investigation was initially undertaken in eight cadaveric specimens and followed by a high-resolution US study in 20 healthy adult volunteers (40 nerves) by two musculoskeletal radiologists in consensus. The location and course of the MCN as well as its relationship to adjacent anatomical structures were evaluated. RESULTS The MCN was consistently identified by US along its entire course. The mean cross-sectional area of the nerve was 1 mm2 (range 0.5-2). The level at which the MCN branched from the tibial nerve was variable, located a mean of 7 mm (range - 7-60) proximal to the tip of the medial malleolus. At the level of the medial retromalleolar fossa, the MCN was located inside the proximal tarsal tunnel a mean of 8 mm (range 0-16) posterior to the medial malleolus. More distally, the nerve was depicted in the subcutaneous tissue at the surface of the abductor hallucis fascia with a mean direct distance to the fascia of 1.5 mm (range 0.4-2.8). CONCLUSIONS High-resolution US can identify the MCN at the level of the medial retromalleolar fossa, as well as more distally in the subcutaneous tissue at the surface of the abductor hallucis fascia. In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of nerve compression or neuroma, and perform selective US-guided treatments. CLINICAL RELEVANCE STATEMENT In the setting of heel pain, sonography is an attractive tool for diagnosing compression neuropathy or neuroma of the medial calcaneal nerve, and enables the radiologist to perform selective image-guided treatments such as diagnostic blocks and injections. KEY POINTS • The MCN is a small cutaneous nerve which rises from the tibial nerve in the medial retromalleolar fossa to the medial side of the heel. • The MCN can be depicted by high-resolution ultrasound along its entire course. • In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of neuroma or nerve entrapment, and perform selective ultrasound-guided treatments such as steroid injection or tarsal tunnel release.
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Affiliation(s)
| | - Daphne Guenoun
- Radiology Department, APHM, Marseille, France
- Aix Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Raphaël Guillin
- Service de Radiologie, Hôpital Sud du CHU de Rennes, 16 Boulevard de Bulgarie, 35000, Rennes, France
| | - Antoine Moraux
- Imagerie Médicale Jacquemars Giélée, 73 Rue Jacquemars Giélée, 59000, Lille, France
| | - Pierre Champsaur
- Radiology Department, APHM, Marseille, France
- Aix Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Thomas Le Corroller
- Radiology Department, APHM, Marseille, France.
- Aix Marseille University, CNRS, ISM UMR 7287, Marseille, France.
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Zemborain ZZ, Soifer M, Azar NS, Murillo S, Mousa HM, Perez VL, Farsiu S. Open-Source Automated Segmentation of Neuronal Structures in Corneal Confocal Microscopy Images of the Subbasal Nerve Plexus With Accuracy on Par With Human Segmentation. Cornea 2023; 42:1309-1319. [PMID: 37669422 PMCID: PMC10635613 DOI: 10.1097/ico.0000000000003319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/24/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE The aim of this study was to perform automated segmentation of corneal nerves and other structures in corneal confocal microscopy (CCM) images of the subbasal nerve plexus (SNP) in eyes with ocular surface diseases (OSDs). METHODS A deep learning-based 2-stage algorithm was designed to perform segmentation of SNP features. In the first stage, to address applanation artifacts, a generative adversarial network-enabled deep network was constructed to identify 3 neighboring corneal layers on each CCM image: epithelium, SNP, and stroma. This network was trained/validated on 470 images of each layer from 73 individuals. The segmented SNP regions were further classified in the second stage by another deep network as follows: background, nerve, neuroma, and immune cells. Twenty-one-fold cross-validation was used to assess the performance of the overall algorithm on a separate data set of 207 manually segmented SNP images from 43 patients with OSD. RESULTS For the background, nerve, neuroma, and immune cell classes, the Dice similarity coefficients of the proposed automatic method were 0.992, 0.814, 0.748, and 0.736, respectively. The performance metrics for automatic segmentations were statistically better or equal as compared to human segmentation. In addition, the resulting clinical metrics had good to excellent intraclass correlation coefficients between automatic and human segmentations. CONCLUSIONS The proposed automatic method can reliably segment potential CCM biomarkers of OSD onset and progression with accuracy on par with human gradings in real clinical data, which frequently exhibited image acquisition artifacts. To facilitate future studies on OSD, we made our data set and algorithms freely available online as an open-source software package.
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Affiliation(s)
| | - Matias Soifer
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Nadim S. Azar
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Sofia Murillo
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Hazem M. Mousa
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Victor L. Perez
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
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Walz B, Pfefferle V, Häfner HM, Kofler L. [Cosmetic and functional results after resection of cutaneous neurofibroma in neurofibromatosis type 1 : Operation of neurofibroma improves quality of life while having moderate complications]. Dermatologie (Heidelb) 2022; 74:961-968. [PMID: 37728798 PMCID: PMC10661718 DOI: 10.1007/s00105-023-05220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Neurofibromatosis type 1, also known as Recklinghausen's disease, is a neurocutaneous tumor syndrome that is genetically determined and is associated with infestation of the integument with neurofibromas (nerve sheath tumors). The occurrence of neurofibromas can be very stressful for patients and often contributes to a reduced quality of life for patients, especially if externally visible body parts are affected. The aim of this study is to show to what extent the resection of cutaneous neurofibromas can improve patients' quality of life. MATERIALS AND METHODS For this study, we conducted a retrospective data collection via questionnaire on the quality of life before and after the surgical removal of cutaneous neurofibromas at the Department of Dermatology, University Hospital of Tübingen. An adapted dermatological quality of life index and a postoperative questionnaire on patient satisfaction were used. In addition, patient data were taken from doctor's notes, surgical reports, and outpatient documentation. A total of 30 patients with neurofibromatosis type 1 who underwent inpatient or outpatient surgery for cutaneous neurofibromas at the Tübingen dermatology hospital between 2016 and 2020 were surveyed. The survey results were statistically analyzed and represented as absolute and relative frequencies. RESULTS Our study indicates an improved quality of life after surgery for cutaneous neurofibromas, especially regarding limitations in everyday life, self-consciousness, the choice of clothing, and leisure activities. The majority of our patients showed no new occurrence of neurofibromas in the surgical area and postoperative bleeding or wound infections were rare. CONCLUSION In relation to the high level of satisfaction with the surgical and cosmetic results and also the positive influence on quality of life, our study indicates a favorable risk-benefit ratio for the resection of cutaneous neurofibromas in neurofibromatosis I.
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Affiliation(s)
- Benjamin Walz
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
| | - Vanessa Pfefferle
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Hans-Martin Häfner
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Lukas Kofler
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Zentrum für Seltene Hauterkrankungen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Hautzentrum skin+more, Holzmarkt 6, 88400, Biberach an der Riss, Deutschland
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Ren X, Chou Y, Wang Y, Jing D, Chen Y, Li X. The Utility of Oral Vitamin B1 and Mecobalamin to Improve Corneal Nerves in Dry Eye Disease: An In Vivo Confocal Microscopy Study. Nutrients 2022; 14:nu14183750. [PMID: 36145126 PMCID: PMC9504679 DOI: 10.3390/nu14183750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/03/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Our purpose is to demonstrate the changes in cornea nerve parameters and symptoms and signs in dry eye disease (DED) patients after oral vitamin B1 and mecobalamin treatment. In this randomized double-blind controlled trial, DED patients were randomly assigned to either the treatment group (oral vitamin B1 and mecobalamin, artificial tears) or the control group (artificial tears). Corneal nerve parameters via in vivo confocal microscopy (IVCM), DED symptoms, and signs were assessed at baseline and 1 and 3 months post-treatment. In total, 398 eyes from 199 patients were included. In the treatment group, there were significant improvements in corneal nerve length, width, and neuromas, the sign of conjunctival congestion score (CCS), symptoms of dryness, pain, photophobia, blurred vision, total symptom score, and OSDI (OSDI) at 1/3 months post-treatment (all p < 0.05). Patients who received vitamin B1 and mecobalamin showed greater improvement in CCS, dryness scores at 1 month (p < 0.05), corneal fluorescein staining (CFS) (p = 0.012), photophobia (p = 0.032), total symptom scores (p = 0.041), and OSDI (p = 0.029) at 3 months. Greater continuous improvement in CFS (p = 0.045), dryness (p = 0.033), blurred vision (p = 0.031) and total symptom scores (p = 0.023) was demonstrated at 3 months than at 1 month post-treatment in the treatment group. We found that oral vitamin B1 and mecobalamin can improve corneal nerve length, width, reflectivity and the number of neuromas in IVCM, thereby repairing epithelial cells and alleviating some ocular symptoms. Thus, vitamin B1 and mecobalamin are potential treatment options for patients with DED.
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Affiliation(s)
- Xiaotong Ren
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Yilin Chou
- Department of Ophthalmology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Yuexin Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Dalan Jing
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Yanyan Chen
- Department of Ophthalmology, Daqing Oilfield General Hospital, Daqing 163311, China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Correspondence: ; Tel.: +86-15611908409
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Erhan SS, Kulduk G, Ozer M. Intriguing Localisation of "Pacinian Neuroma''<br /> Diagnosed at Intraoperative Consultation during Whipple Procedure. J Coll Physicians Surg Pak 2021; 31:1520-1521. [PMID: 34794304 DOI: 10.29271/jcpsp.2021.12.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/23/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Selma Sengiz Erhan
- Department of Pathology, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Gamze Kulduk
- Department of Pathology, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Mehmet Ozer
- Department of Pathology, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
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Choi GG, Lee HJ, Han HJ, Jeong YB, Lee HB, Park JH. Mucosal Neuroma Cues for Endocrine Emergency Treatment. Endocrinol Metab (Seoul) 2021; 36:1312-1313. [PMID: 34856654 PMCID: PMC8743591 DOI: 10.3803/enm.2021.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Gyu Gang Choi
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju,
Korea
| | - Hwan Jin Lee
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju,
Korea
| | - Hyo Jin Han
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju,
Korea
| | - Young Beom Jeong
- Department of Urology, Jeonbuk National University Medical School, Jeonju,
Korea
| | - Heung Bum Lee
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju,
Korea
| | - Ji Hyun Park
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju,
Korea
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Lee JA, Smith BT, Egro FM, Stanger M, Koster W, Grunwaldt LJ. Timing of Nerve Recovery After Nerve Grafting in Obstetrical Brachial Plexus Palsy Patients With Isolated Upper Trunk Neuromas. Ann Plast Surg 2021; 87:446-450. [PMID: 34559713 DOI: 10.1097/sap.0000000000002939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The timing of nerve recovery after nerve grafting in obstetrical brachial plexus palsy patients has not been well reported. One prior study reported a return to baseline function at 3 to 6 months postoperatively. However, there is a paucity of studies to corroborate this timing, and there have been no studies delineating the timeline to obtain clinically meaningful function. METHODS OBPP patients with upper trunk neuromas-in-continuity who were treated with resection and sural nerve grafting at a single institution were studied. Time to return to baseline function was assessed by Active Movement Scale (AMS) scores preoperatively and postoperatively. Time to clinically meaningful function, defined as an AMS score of ≥6, was also assessed. RESULTS Eleven patients with isolated upper trunk neuromas-in-continuity underwent excision and reversed sural nerve grafting. Three of 11 patients also underwent spinal accessory to suprascapular nerve transfers. Average age at surgery was 9.8 ± 1.9 months. One patient did not have follow-up data and was excluded. Average follow-up was 37.1 ± 16.8 months. Average return to baseline AMS score was approximately 4 to 8 months for shoulder abduction, shoulder flexion, shoulder external rotation, elbow flexion, and forearm supination. Clinically meaningful function was obtained in most patients between 9 and 15 months. The remaining patients who did not achieve clinically meaningful function had all obtained scores of 5, which reflects less than one half normal range of motion against gravity. CONCLUSIONS Nerve recovery after surgical intervention in OBPP patients who undergo resection of an upper trunk neuroma-in-continuity and nerve grafting is more rapid than in adults but longer than previously reported in OBPP literature. This study provides an important data point in delineating the timeline of nerve recovery.
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Affiliation(s)
- Jessica A Lee
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Brandon T Smith
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Francesco M Egro
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Meg Stanger
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Wendy Koster
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Lorelei J Grunwaldt
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
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Luryi AL, Michaelides EM, Babu S, Bojrab DI, Kveton JF, Hong RS, Zappia J, Sargent EW, Schutt CA. Reliability of clinical diagnosis of masses of the cerebellopontine angle: A retrospective multi-institutional study. Am J Otolaryngol 2019; 40:133-136. [PMID: 30717992 DOI: 10.1016/j.amjoto.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/18/2019] [Accepted: 01/28/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the accuracy of pre-operative diagnosis of masses of the cerebellopontine angle (CPA) when compared to surgical pathology. DESIGN Retrospective chart review. PARTICIPANTS Patients who underwent surgery for CPA masses at two tertiary care institutions from 2007 to 2017. MAIN OUTCOME MEASURES Percent concordance between pre-operative and surgical pathologic diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value for predicted diagnoses. RESULTS Concordance between pre-operative diagnosis and surgical pathology was 93.2% in 411 sampled patients. Concordance was 57.9% for masses other than vestibular schwannoma. Prediction of vestibular schwannoma and meningioma had high positive (0.95 and 0.97, respectively) and negative (0.76 and 0.99, respectively) predictive values. Prediction of facial neuroma had sensitivity of 0.13 and positive predictive value of 0.25. Headache (p = 0.001) and facial weakness (p = 0.003) were significantly associated with different pathologic profiles. Hearing loss was associated with differences in diagnostic prediction (p = 0.02) but not with differences in surgical pathology (p > 0.05). CONCLUSIONS Comparison between pre-operative predicted diagnosis and surgical pathology for cerebellopontine angle masses is presented. Vestibular schwannoma and meningioma were effectively identified while rarer CPA masses including facial neuroma were rarely identified correctly. Clinicians caring for patients with CPA masses should be mindful of diagnostic uncertainty which may lead to changes in treatment plan or prognosis.
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Affiliation(s)
- Alexander L Luryi
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06511, United States
| | - Elias M Michaelides
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06511, United States
| | - Seilesh Babu
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - John F Kveton
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06511, United States
| | - Robert S Hong
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - John Zappia
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - Eric W Sargent
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States
| | - Christopher A Schutt
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, 30055 Northwestern Highway, Suite #101, Farmington Hills, MI 48334, United States.
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Robb-Nicholson C. Ask the doctor. I have pain in the ball of my foot, which my doctor thinks is caused by a Morton's neuroma. How did I get this and what can I do about it? Harv Womens Health Watch 2013; 20:2. [PMID: 27024523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Chen L, Gu YD, Hu SN. Functional reconstruction of the irreparable upper trunk defect of the brachial plexus--a case report. Hand Surg 2004; 9:125-9. [PMID: 15368641 DOI: 10.1142/s0218810404002108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Accepted: 03/17/2004] [Indexed: 11/18/2022]
Abstract
We report a successful application of Oberlin's procedure combined with transfer of trapezius and latissimus dorsi with the teres major for reconstruction of elbow flexion as well as abduction and external rotation of the shoulder to a ten-year-old patient, who had a long defect of the left brachial plexus upper trunk caused by resection of the plexiform neuroma.
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Affiliation(s)
- Liang Chen
- Hua-Shan Hospital, Shanghai, P.R. China.
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Ho SY, Kveton JF. Rapid growth of acoustic neuromas after stereotactic radiotherapy in type 2 neurofibromatosis. Ear Nose Throat J 2002; 81:831-3. [PMID: 12516377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
We describe a rare complication of stereotactic radiotherapy for large acoustic neuromas in a patient with type 2 neurofibromatosis. We retrospectively reviewed the case of a 14-year-old girl who had been referred to our tertiary care center. Prior to referral, the patient had been evaluated for hoarseness. During the work-up, magnetic resonance imaging (MRI) detected two large bilateral acoustic neuromas and two bilateral jugular foramen tumors. The patient was diagnosed with type 2 neurofibromatosis, and she underwent stereotactic radiotherapy for treatment of the two acoustic neuromas; the jugular foramen tumors were not irradiated. The patient's post-treatment course was complicated by hydrocephalus and symptoms of brainstem compression, which required urgent surgical intervention. Follow-up MRI 7 months following radiotherapy demonstrated a rapid growth of the acoustic neuromas, but no appreciable change in the size of the jugular foramen neuromas. These findings suggest that the radiotherapy might have been the cause of the rapid growth of the acoustic neuromas. To our knowledge, no such report has been published in the literature, and this phenomenon might be unique. Our findings suggest that radiotherapy might not be the optimal first-line treatment for acoustic neuromas in patients with type 2 neurofibromatosis.
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Affiliation(s)
- Steven Y Ho
- Department of Otolaryngology, Northwestern University School of Medicine, 1000 Central St., Suite 610, Evanston, IL 60202, USA.
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Zoref-Shani E, Boer P, Brosh S, Pelled D, Bromberg Y, Sperling O. Purine nucleotide metabolism in cultured neurons and astroglia from HPRT-deficient knockout mice. Ital J Biochem 2001; 50:9-13. [PMID: 12170582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- E Zoref-Shani
- Department of Clinical Biochemistry, Tel-Aviv University, Tel-Aviv, Israel
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Avilés-Trigueros M, Sauvé Y, Lund RD, Vidal-Sanz M. Selective innervation of retinorecipient brainstem nuclei by retinal ganglion cell axons regenerating through peripheral nerve grafts in adult rats. J Neurosci 2000; 20:361-74. [PMID: 10627613 PMCID: PMC6774129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The pattern of axonal regeneration, specificity of reinnervation, and terminal arborization in the brainstem by axotomized retinal ganglion cell axons was studied in rats with peripheral nerve grafts linking the retina with ipsilateral regions of the brainstem, including dorsal and lateral aspects of the diencephalon and lateral aspect of the superior colliculus. Four to 13 months later, regenerated retinal projections were traced using intraocular injection of cholera toxin B subunit. In approximately one-third of the animals, regenerated retinal axons extended into the brainstem for distances of up to 6 mm. Although axons followed different patterns of ingrowth depending on their site of entry to the brainstem, within the pretectum, they innervated preferentially the nucleus of the optic tract and the olivary pretectal nucleus in which they formed two types of terminal arbors. Within the superior colliculus, axons extended laterally and formed a different terminal arbor type within the stratum griseum superficiale. In the remaining two-thirds of the animals, retinal fibers formed a neuroma-like structure at the site of entry into the brainstem, or a few fibers extended for very short distances within the neighboring neuropil. These experiments suggest that regenerated retinal axons are capable of a highly selective reinnervation pattern within adult denervated retinorecipient nuclei in which they form well defined terminal arbors that may persist for long periods of time. In addition, these studies provide the anatomical correlate for our previous functional study on the re-establishment of the pupillary light reflex in this experimental paradigm.
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Affiliation(s)
- M Avilés-Trigueros
- Laboratorio de Oftalmología Experimental, Departamento de Oftalmología, Facultad de Medicina, Universidad de Murcia, E-30100 Espinardo, Murcia, Spain
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Kalb RL. Evaluation and treatment of foot and ankle pain. Hosp Pract (1995) 1998; 33:127-8, 131-2. [PMID: 9717487 DOI: 10.1080/21548331.1998.11443735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Successful treatment of the multiple endocrine neoplasia type III (MEN III) syndrome requires early diagnosis. It is highly possible that the patient's dentist may be the first practitioner with the opportunity to diagnose this potentially fatal syndrome. Additionally, patients with this syndrome having a pheochromocytoma and needing invasive dental treatment pose a life-threatening dental management risk. This article presents a review of the MEN II syndrome and a case report on the surgical management of a MEN III patient with a pheochromocytoma.
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Affiliation(s)
- C W Haveman
- Advanced General Dentistry Clinic, The University of Texas Health Science Center at San Antonio, 78284-7914, USA
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Smith DE, Dickson JA. Colonic neuronal dysplasia: a post-script. Acta Paediatr Scand 1991; 80:871-2. [PMID: 1683504 DOI: 10.1111/j.1651-2227.1991.tb11963.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- D E Smith
- Department of Paediatrics, Children's Hospital, Sheffield, England
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37
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Silverman IJ. Three neuromas of one foot. J Am Podiatr Med Assoc 1987; 77:353-4. [PMID: 3612514 DOI: 10.7547/87507315-77-7-353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Seltzer Z, Rappaport ZH, Zagzag D. A chronically implanted delivery system of drugs to a nerve-end neuroma: effects on a behavioural chronic pain model. J Neurosci Methods 1985; 13:223-9. [PMID: 4010332 DOI: 10.1016/0165-0270(85)90070-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Autotomy has been suggested as an animal model of chronic pain. It starts about a week or two postoperatively and develops until 10 weeks after nerve section. This behaviour is thought to be triggered by activity of sensory fibres ending in a neuroma. Here we suggest to utilize it in combination with a novel drug delivery system which enables a direct and exclusive access of the drug to the neuroma. Alteration in the autotomy behaviour can then be related to the exclusive topical action on the sensory fibres within the neuroma. The sciatic nerve is transsected and its proximal end inserted into a PE tube sealed distally. A second, smaller tube originates in a wound exit in the back of the animal and subcutaneously leads into the large tube, where it is fixed by glue to the inner wall. Thus, the end of the smaller tube is juxtaposed to the nerve end. During the following weeks a neuroma develops within the tube. The resulting autotomy scores are then examined weekly. At various times after the operation, under light anaesthesia, drugs can be injected into the tube and the effect on the autotomy behaviour is monitored. An example is given, describing the autotomy suppressive effects of glycerol and alcohol, injected to different groups of rats immediately after the operation and compared to an injection 14 days postoperatively. This method is suggested as a pharmaco-behavioural assay for the assessment of the analgetic efficacy of drugs for chronic pain.
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Mierzecki AM, Listewník MJ, Kotańska K. [Repeated resection of pulmonary metastasis of malignant neuroma originating in the lower limb]. Pneumonol Pol 1985; 53:209-12. [PMID: 4047947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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41
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Martinelli C, Matheus G, Callestini EA, de Campos Russo M. [Melanotic neuroectodermal tumor of infancy]. Ars Curandi Odontol 1980; 6:3-8. [PMID: 6933978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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42
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Runne U. [Syndrome of multiple neuromas. ("Multiple mucosal neuroma" syndrome)]. Z Hautkr 1977; 52:302-4. [PMID: 860541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Nakano H, Mori K, Fukushige M, Nihira H, Hayashi Y. [A syndrome of multiple mucosal neuroma, medullary thyroid carcinoma and pheochromocytoma: report of a case (author's transl)]. Nihon Hinyokika Gakkai Zasshi 1977; 68:294-307. [PMID: 558452 DOI: 10.5980/jpnjurol1928.68.3_294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Bartley PC, Lloyd HM, Aitken RE. Medullary carcinoma of the thyroid, multiple phaeochromocytomas, mucosal neuromas, marfanoid habitus and other abnormalities (Sipple's syndrome). Med J Aust 1976; 2:173-6. [PMID: 979836 DOI: 10.5694/j.1326-5377.1976.tb134453.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A case of Sipple's syndrome is reported, in which the full phenotype was expressed. The patient had the typical marfanoid habitus, with thickened lips and alae nasi, neuromas on lips and tongue, medullary carcinoma of the thyroid gland, phaeochromocytomas, and medullated corneal nerve fibres. The plasma calcitonin level was initially elevated, rose on calcium infusion before thyroidectomy, and was undetectably after thyroidectomy. The urinary catecholamine excretion was elevated. The plasma parathyroid hormone, adrenocorticotrophin and growth hormone levels and the serum calcium level were normal.
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Dobrescu G, Bârsu M, Florea N, Dobrescu A, Rener C. [Lesions of the lips and their malignant potential]. Morphol Embryol (Bucur) 1976; 22:171-8. [PMID: 134273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Caldarone CV. Considerations in examination: an overview for the dental profession. R I Dent J 1975; 8:15-7 contd. [PMID: 1065921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Escourolle R, Poirier J. [Anatomical review of the posterior fossa. Histological and topographical classification of tumors]. Rev Prat 1973; 23:3417-26 passim. [PMID: 4801818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Gorbunova VG. [Various errors in primary nerve suture]. Vestn Khir Im I I Grek 1972; 109:109-12. [PMID: 4577358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Lee HT. Amputation neuroma of the maxilla. Dent J Malaysia Singapore 1971; 11:17-9. [PMID: 5288001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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