A supportive donor nerve for long-term facial paralysis: Anatomical analysis of the posterior auricular nerve and micro-anatomical comparison with zygomatic nerve

BACKGROUND

The posterior auricular nerve (PAN) is an inspiring candidate for the additional axonal source in long-term facial paralysis to improve the functional results of the cross-facial nerve (FN) graft technique. However, no studies have analyzed the PAN's axonal load and its microscopic anatomy to assess its utilization in facial reanimation. The present study aims to examine the anatomical and microscopic features of the PAN to analyze its feasibility as a donor nerve.

METHODS

The bilateral facial side of 14 fresh frozen adult human cadavers was examined for the study. The PAN's anatomical course was recorded, and nerve specimens from the PAN and zygomatic nerve (ZN) were obtained to compare their microscopic anatomy and axon counts using a light microscope and transmission electron microscope.

RESULTS

The PAN's average branching distance and its course length were 5.8 ± 2.69 mm and 59.2 ± 5.85, respectively. The mean number of myelinated axons was 600.28 ± 69.97 in the PAN and 728.85 ± 166.31 in the ZN. This difference between the two nerves was statistically significant (p = 0.002). However, considering the gender variable, the mean axon counts of PAN and ZN were statistically similar for face sides and their average. Furthermore, the ultrastructural anatomy of both nerves was similar in electron microscopic evaluation.

CONCLUSIONS

The present study confirms that the PAN is a proper candidate to be a supportive donor nerve due to its isolated site, consistent anatomical course, convenient ultrastructural anatomy as well as axonal load.

An Intervention Study to Increase the Medication Compliance of 60 Years and Older Individuals

Background

In older age, taking medication at the desired level contributes to the health and well-being, and therefore, constitutes an essential part of the effectiveness of treatment and ultimately desired public health impact and reduced healthcare budgets. However, it is known that medication compliance among older persons is frequently not at a desired level. Therefore, in this study, it was aimed to increase medication compliance through an educational intervention for patients aged 60 and over, who applied to two healthcare facilities in Ankara, Turkey.

Methods

This intervention study was implemented in two public health hospitals between March and June 2019. 315 people aged 60 and over participated in the study. The intervention tool was the “teach-back” method. SPSS program was used for data entry and analysis. P value less than 0.05 was indicated for statistical significance.

Results

Mean age of the participants was found to be 70.16±7.9 for the control group and 70.27±7.4 for the intervention group. In the intervention group, a statistically significant increase was found in the capacity of learning the long-term benefits of drugs, their side effects and storage conditions, and knowing when the drugs shouldn't be taken, and repeating information about the drugs used (p = 0.000).

Conclusions

This study has revealed that medication compliance among older individuals can be increased with an appropriate communication and training method in healthcare settings. Time allocated by health workers in this regard has a potential to respond to the compliance-related needs. With the “Teach-back” method utilized in the interactions between older patients and health workers, it is possible to attain meaningful, large-scale and cost-effective public health outcomes that contribute to the clinical benefits of treatments and the effectiveness of health systems.

Key messages

Older people are open to receive information on the actual health needs. A well-structured interaction between healthcare workers and patients involving “teach-back” method contributes to medication compliance among the elderly.

The prevalence of non-vascular pulmonary manifestations in Takayasu's Arteritis patients: A Retrospective multi-centred Turkish cohort study

Objectives Takayasu's arteritis (TAK) is a rare vasculitis characterized by inflammation of intermediate- to large-size arteries. Although pulmonary artery involvement (PAI) is an expected finding in some TAK patients, data on non-vascular pulmonary involvement (NVPI) are limited. We aimed to investigate the frequency of NVPI, including parenchymal infiltration, nodules/cavities, pleural effusion, and haemorrhage, in TAK.Method We assembled a retrospective cohort of TAK patients from nine tertiary centres in Turkey. The demographics and clinical characteristics of patients were extracted from medical records and the imaging findings were evaluated for pulmonary manifestations.Results As of January 2021, 319 TAK patients (female/male 276/43; mean age 42.4 ± 13.5 years) were recruited. Eighty-two patients had cough and/or dyspnoea and four had haemoptysis as pulmonary symptoms. On computed tomography assessment, the overall frequency of NVPI was 7.2%; parenchymal infiltrations were present in 10 (3.1%), pleural effusion in eight (2.5%), nodules/cavities in six (1.9%), and pulmonary haemorrhage in four patients (1.3%). In the whole cohort, 10.3% of patients had pulmonary artery hypertension (PAH) and 5.6% had PAI. Among patients with PAH or PAI, the overall frequency of NVPI was significantly higher than in the rest of the group.Conclusions In this TAK cohort from Turkey, we observed NVPI in 7.2% of patients, with parenchymal infiltrations being the most common, followed by pleural effusion. Notably, NVPI was more frequent in patients with PAH or PAI. Although not as common as PAI, NVPI should be kept in mind, especially in TAK patients with PAH or PAI.

Clinicopathological and Prognostic Features of 67 Cases with Pulmonary Sarcomatoid Carcinoma: An 18-Year Single-Centre Experience

INTRODUCTION

Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small-cell lung cancer (NSCLC). It is frequently diagnosed in the advanced stage and is resistant to conventional chemotherapeutics. Due to the unique nature and rarity, we evaluated the epidemiological, clinicopathological, and survival data of PSC patients treated at our centre.

PATIENTS AND METHODS

We retrospectively collected demographic and clinical data of 67 PSC patients from a single tertiary referral hospital, between the 2000 and 2018. Univariate and multivariate analyses were performed to determine the risk factors affecting survival.

RESULTS

The median age was 61 years, and the percentage of male was 74.6%. Most of the patients had a smoking history (76.9%). The most common PSC subtype was pleomorphic carcinoma (46.3%). The median overall survival (OS) was 55.4 months, and the 5-year OS rate was 47.5%. Advanced stage, T4 tumour, and positive lymph node involvement were associated with poor OS (p < 0.05). The patients with negative epithelial markers had poorer prognosis (p = 0.027) and had more frequently stage IV disease (p = 0.016). Surgical treatment and stage IV disease were determined to be independent prognostic factors.

CONCLUSION

PSC is an extremely rare and aggressive variant of NSCLC. Positive epithelial markers may have favourable prognostic significance in PSC. Resection of the tumour with a negative surgical margin is crucial for better survival. The prognosis of the disease is very poor in the metastatic stage.

Rewinding sarcopenia: a narrative review on the renin-angiotensin system

BACKGROUND AND AIMS

The purpose of this review was two-fold. First, we aimed to provide an in-depth glance on the relationship between renin-angiotensin system (RAS) dysregulation and sarcopenia. Second, we aimed to touch upon potential treatments of sarcopenia (including RAS blockers, vitamin D, and exercise) in light of the pertinent literature.

METHODS

Currently available research regarding the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers on knee extensor strength, grip strength, chair stand test, gate speed together with the effects of exercise on muscle mass, strength, physical performance, blood pressure and cognitive tests (particularly in older adults) was reviewed.

RESULTS

Although some studies have shown favorable effects of ACEIs on muscle strength and/or physical function tests, some studies have reported no/negative association in between. The favorable impact of exercise on reducing blood pressure is shown, and exercise treatment is widely recommended in the relevant literature. Different types of exercises (aerobic, resistance, dancing, music movement, water-based, golf, knitting activities or multicomponent exercises) have shown improvement in cognitive functions as well.

CONCLUSION

Classical RAS activity results in deleterious effects not only on the cardiovascular but also on the neuromusculoskeletal system. Therefore, treatments targeting inhibition of the classical RAS activity seem to be important in the management of several age-related pathologies, including sarcopenia. As such, ACEIs, vitamin D, exercise, and healthy diet can have prominent effects not only on the modulation of RAS but also on physical and cognitive functions and sarcopenia as well.

Analysis of 1430 hand fractures and identifying the 'Red Flags' for cases requiring surgery: Head: Hand Fracture Treatment

BACKGROUND

Hand fractures constitute 20% of hand injury patients who apply to emergency services. Conservative approaches are satisfactory in the majority of the cases. However, the minority group in need of surgery reaches a serious number of patients considering the frequency of these injuries. Retrospective questioning of the indications of the performed surgeries is a proper way of understanding the decisional process for surgery.

PATIENTS/METHODS

Patients treated for hand fractures were retrospectively reviewed. Patient gender, age, finger/fingers involved, soft tissue involvement, treatment method (conservative/surgery) and if operated, devices used for fixation were noted. Plain radiographs of the patient were evaluated. Descriptive statistics of these variables and the effect of each variable on the decision for surgery were analyzed.

RESULTS

The study involved 1430 fractures of 1303 patients (1016 male and 287 female). Fifth finger was the most commonly injured digit (31%). Comminuted fractures (29%) followed by transverse fractures (29%) and spiral/oblique fractures (22%) were commonly diagnosed fracture types. Thirteen percent (13%) of the study group needed tendon/nerve/vessel repairs. Male patients, cases with soft tissue involvement, second, third and fourth finger fractures, fractures involving multiple digits, fractures with an intra-articular component, fractures with dislocation more than 4 mm and angulation more than 15° had a significantly higher rate of surgery.

CONCLUSION

Less than half of the hand fractures require surgery, and conservative treatment is usually preferred. Certain variables that indicate surgical treatment were identified with our study. These findings may help to weigh the options and choose the right path in doubtful conditions.

LEVEL OF EVIDENCE

Level 4, Case-control study.

Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM

Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. It is a precursor of physical frailty, mobility limitation, and premature death. Muscle loss is mainly due to the loss of type II muscle fibres, and progressive loss of motor neurones is thought to be the primary underlying factor. Anterior thigh muscles undergo atrophy earlier, and the loss of anterior thigh muscle function may therefore be an antecedent finding. The aim of this review is to provide an in-depth (and holistic) neuromusculoskeletal approach to sarcopenia. In addition, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), a novel diagnostic algorithm is proposed, developed with the consensus of experts in the special interest group on sarcopenia (ISarcoPRM). The advantages of this algorithm over the others are: special caution concerning disorders related to the renin-angiotensin system at the case finding stage; emphasis on anterior thigh muscle mass and function loss; incorporation of ultrasound for the first time to measure the anterior thigh muscle; and addition of a chair stand test as a power/performance test to assess anterior thigh muscle function. Refining and testing the algorithm remains a priority for future research.

Late Onset of an Overlooked Follicular Thyroid Carcinoma Presenting as a Chest Wall Tumor 10 Years Following Thyroidectomy

Objective

Metastatic chest wall tumors resulting from thyroid carcinomas are not unusual; however, the late onset of metastasis of a follicular thyroid carcinoma (FTC) is extremely rare. We aim to present a report of a case with chest wall metastasis of an FTC 10 years following thyroidectomy.

Methods

Among the studies performed were chest wall tumor imaging, serum thyroid stimulating hormone determination, and histopathology of the chest wall tumor and thyroid tissue examination.

Results

An asymptomatic 28-year-old woman was noted to have a left-sided chest wall mass on a chest X-ray performed for a job application. She had a history of right hemithyroidectomy 10 years prior to her admission, which had been reported as a thyroid follicular adenoma. Computed tomography showed a tumor measuring 75 × 50 mm in diameter localized at the left paravertebral region. The maximum standardized uptake value of the tumor was seven in positron emission tomography. Histopathologic finding of the trucut biopsy of the chest wall tumor revealed metastasis of a differentiated thyroid carcinoma. The patient underwent a completion left hemithyroidectomy with chest wall resection and reconstruction. Previous right hemithyroidectomy material was examined and diagnosed as minimally invasive FTC. Histopathologic finding of the resected chest wall tumor was consistent with metastasis of an FTC.

Conclusions

Although extremely rare, the late metastasis of a thyroid carcinoma should be considered in the differential diagnosis of patients with chest wall tumors who have a previous history of thyroidectomy even with a diagnosis of benign tumor.

Reassessing Sarcopenia in Hypertension: STAR and ACE Inhibitors Excel

BACKGROUND

Hypertension and sarcopenia are commonly seen in older adults. The renin-angiotensin system and the therapeutic use of angiotensin-converting enzyme (ACE) inhibitors have been on the agenda of sarcopenia in different perspectives. Our aim was to explore the frequency of sarcopenia in patients with hypertension and to investigate the association between the use of ACE inhibitors and sarcopenia.

METHODS

A total of 272 community-dwelling adults were recruited. Anterior thigh muscle thickness was measured by ultrasound. Handgrip strength, gait speed, and chair stand test were evaluated. Low muscle mass was diagnosed in the presence of low sonographic thigh adjustment ratio (STAR) values and sarcopenia was diagnosed if low STAR values were coupled with low functional tests.

RESULTS

136 subjects (50.0%) had no comorbid disease; 102 (37.5%) had one, 21 (7.7%) had two, nine (3.3%) had three and four (1.5%) had four comorbid diseases. Both low muscle mass (41.9% vs 13.2%) and sarcopenia (32.2% vs 7.8%) were more commonly seen in hypertensive when compared with normotensive older adults. Subgroup analysis of older adults with hypertension revealed that sarcopenia was less prevalent (P = .003) in patients using ACE inhibitors (8.7%) than those using angiotensin II receptor blockers (48.7%) and other antihypertensive drugs (46.4%). After binary logistic regression analyses; only the presence of hypertension seemed to independently predict the development of sarcopenia in older adults [OR = 6.5 (95% CI: 2.4-17.8, P < .001)].

CONCLUSIONS

Sarcopenia is highly prevalent in hypertensive older adults. Amongst many antihypertensive medications, ACE inhibitors seem to have favourable effects on both disorders.

Letter to the Editor: Adjusting Anterior Thigh Muscle Measurements Using Ultrasound in Sarcopenia

We have read with great interest the recently published article by Tsukasaki et al (1). We congratulate the authors for drawing attention to regional muscle mass measurements for evaluating sarcopenia. As they highlighted, age-related muscle loss occurs initially in the anterior thigh muscles that predominantly contain fast-twitch (type II) fibers (2). Therefore, regional muscle mass and functional assessments are important for the early diagnosis and follow-up of sarcopenia (2). In this regard, computed tomography (CT), magnetic resonance imaging, ultrasound (US) and dual-energy X-ray absorptiometry (DXA) techniques give opportunity for regional muscle mass measurements. Likewise, the authors compared the relationships among regional/total muscle mass measurements, muscle power, strength and performance tests. Although we agree with them in general, we would like to add further.