A Rare Case of Isolated Spontaneous Common Carotid Artery Dissection Treated by Telescoping Stents

An isolated spontaneous common carotid artery (CCA) dissection is an extremely rare cause of stroke, and standard treatment guidelines are not yet established. This case report presents a rare case of isolated spontaneous CCA dissection but with typical and obvious radiological findings, and it could be informative and educational to clinicians. Telescoping multiple carotid stents can be a feasible treatment option for this case with recurrent ischemia due to a long segment dissection.

Increasing Performance of Spiral-Wound Modules (SWMs) by Improving Stability against Axial Pressure Drop and Utilising Pulsed Flow

Spacer-induced flow shadows and limited mechanical stability due to module construction and geometry are the main obstacles to improving the filtration performance and cleanability of microfiltration spiral-wound membranes (SWMs), applied to milk protein fractionation in this study. The goal of this study was first to improve filtration performance and cleanability by utilising pulsed flow in a modified pilot-scale filtration plant. The second goal was to enhance membrane stability against module deformation by flow-induced friction in the axial direction ("membrane telescoping"). This was accomplished by stabilising membrane layers, including spacers, at the membrane inlet by glue connections. Pulsed flow characteristics similar to those reported in previous lab-scale studies could be achieved by establishing an on/off bypass around the membrane module, thus enabling a high-frequency flow variation. Pulsed flow significantly increased filtration performance (target protein mass flow into the permeate increased by 26%) and cleaning success (protein removal increased by 28%). Furthermore, adding feed-side glue connections increased the mechanical membrane stability in terms of allowed volume throughput by ≥100% compared to unmodified modules, thus allowing operation with higher axial pressure drops, flow velocities and pulsation amplitudes.

Intussusception Allograft Prosthetic Composites in Total Hip Arthroplasty: A Salvage Operation for Extensive Femoral Bone Loss

BACKGROUND

Allograft prosthetic composites (APCs) have been used to perform revision total hip arthroplasty (THA) for massive femoral bone loss or deformity. Intussusception, or "telescoping", APC techniques have been proposed to enhance the contact area of this interface and provide superior mechanical fixation over conventional methods. The purpose of this study is to present to our knowledge, the largest series of telescoping APC THAs, along with surgical technique details and midterm (average 5-10 years) clinical results.

METHODS

Between 1994 and 2015, 46 revision THAs performed with proximal femoral telescoping APCs were retrospectively reviewed at a single institution. Overall survival, reoperation-free survival, and construct survival rates were calculated via Kaplan-Meier methods. In addition, radiographic analyses were performed to evaluate for component loosening, union at the APC-host interface, and resorption of the allograft.

RESULTS

At 10 years, the overall patient survival was 58%, reoperation-free survival was 76%, and construct survival was 95%. Reoperation was performed in 20% (n = 9) and only 2 constructs required resection. Radiographic analyses performed at latest follow-up revealed no instances of radiographic femoral stem loosening, an 86% union rate at the APC-host site, 23% with signs of some allograft resorption, and a 54% trochanteric union. The mean postoperative Harris hip score was 71 points (range, 46-100).

CONCLUSION

Telescoping APCs are technically demanding, but provide reliable mechanical fixation for the reconstructing of large proximal femoral bone deficits in revision THA with excellent construct survivorship, acceptable reoperation rates, and good clinical outcomes.

LEVEL OF EVIDENCE

IV.

Evolution and development of the cetacean skull roof: a case study in novelty and homology

Skulls of living whales and dolphins (cetaceans) are telescoped-bones of the skull roof are overlapped by expanded facial bones and/or anteriorly extended occipital bones. Evolution of the underlying skull roof (calvarium), which lies between the telescoped regions, is relatively unstudied. We explore the evolution and development of the calvarium of toothed whales (odontocetes) by integrating fetal data with Oligocene odontocete fossils from North America, including eight neonatal and juvenile skulls of Olympicetus†. We identified two potential synapomorphies of crown Cetacea: contact of interparietals with frontals, and a single anterior median interparietal (AMI) element. Within Odontoceti, loss of contact between the parietals diagnoses the clade including Delphinida, Ziphiidae and Platanistidae (=Synrhina). Delphinida is characterized by a greatly enlarged interparietal. New fetal series of delphinoids reveal a consistent developmental pattern with three elements: the AMI and bilateral posterior interparietals (PIs). The PIs most resemble the medial interparietal elements of terrestrial artiodactyls, suggesting that the AMI of cetaceans could be a unique ossification. More broadly, the paucity of conserved anatomical relationships of the interparietals, as well as the fact that the elements often do not coalesce into a single bone, demonstrates that assessing homology of the interparietals across mammals remains challenging. This article is part of the theme issue 'The mammalian skull: development, structure and function'.

Surgical Strategy to Decrease the Revision Rate of Fassier-Duval Nailing in the Lower Limbs of Osteogenesis Imperfecta

(1) Background: The Fassier−Duval (FD) nail was developed for the treatment of osteogenesis imperfecta (OI). The aim of this study was to review the results of OI patients treated with the FD nail at our institution and discuss a surgical strategy to decrease the FD nail revision rate; (2) Methods: We retrospectively reviewed OI patients treated at our institution between 2015 and 2020. OI patients treated with FD nail insertion in the long bones of the lower extremities were included, and those with a follow-up duration <1 year or incomplete radiographs were excluded. Data on the type of OI, age, sex, use of bisphosphonate treatment, and nail failure were recorded; (3) Results: The final cohort consisted of seven patients (three females and four males) with ten femurs and ten tibiae involved. Six of the patients had type III OI, and one had type IV OI. An exchange of implant was required in 11 limbs. The average interval between previous FD nail insertion and revision surgery was 2.4 years; (4) Discussion: The main reasons for revision surgery were migration of the male/female component, refracture/nail bending, and delayed union. In the femur, migration of the female component or nail bending were common reasons for failure, while migration of the male component and delayed union were common in the tibia; (5) Conclusions: Surgery for OI patients is challenging, and physicians should aim to minimize complications and the need for revision. Sufficient depth of purchase, center−center nail position, and adequate osteotomy to correct bowing are the key factors when using the FD nail.

Postoperative subtype P as a risk factor for excessive postoperative sliding of cephalomedullary nail in femoral trochanteric fractures in old patients: A case series of 263 patients using computed tomography analysis

INTRODUCTION

Although excellent results of cephalomedullary nailing for femoral trochanteric fractures have been reported, excessive sliding has recently been noted as a cause of lag screw cut-out. Excessive sliding is reported as sliding of ≥8mm, which occurs in approximately 40%of cases. This study aimed to evaluate the risk factors for excessive sliding.

PATIENTS AND METHODS

Overall, 551 patients who underwent cephalomedullary nail surgery between 2016 and 2021 were recruited. Patients aged ≥65 years who underwent preoperative computed tomography (CT), experienced low-energy trauma, and received follow-up for >4 months were included. Cases were retrospectively reviewed for their postoperative sliding distance and the percentage of excessive sliding (>8 mm). 3D-CT classification, reduction pattern (subtypes A, N, and P) in the lateral view, medullary mismatch, and implant type (short/long Gamma3 nail and INTERTAN) were investigated fortheirimpact on sliding distance andtheincidence of excessive sliding. Complication rates (lag screw cut-out and non-union) were also assessed.

RESULTS

Overall, 263 patients (mean age, 84.0±7.4; 186 women) were recruited. The median (range) sliding distance was 3.5 (0-20) mm, and 42 cases (16.0%) had excessive sliding. Sliding distance was significantly smaller in the 2-fragment group than in the 3-fragment group (GP+GA and GP+L) (p=0.02); however, there were no significant differences between the 2-fragment and other fracture-type groups, including the 3-fragment group (GP, GA, GP ± GA, GP ± L), 4-fragmentgroup(GP/L, GP ± L/GA, GP±GA/L), and 5-fragmentgroup. There was no significant difference in sliding distance according to postoperative reduction type between the groups (p=0.83) and no correlation between medullary mismatch and sliding distance. The amount of sliding and rate of excessive sliding were significantly lower in the INTERTAN group than in the Gamma3 nail groups (p<0.01). Logistic regression analysis with excessive sliding as the variable revealed reduction type P as the only risk factor (p=0.024, odds ratio 2.99). There were three lag screw cut-out (1.1%) cases and one non-union (0.4%) case.

CONCLUSIONS

Postoperative subtype P is a risk factor for excessive sliding; there was significantly less sliding in the INTERTAN nail group. It is necessary to avoid reduction to subtype P to prevent postoperative excessive sliding.

LEVEL OF EVIDENCE

IV.

Characteristics of phantom limb pain in U.S. civilians and service members

OBJECTIVES

The population of Americans with limb loss is on the rise, with a different profile than in previous generations (e.g., greater incidence of amputation due to diabetes). This study aimed to identify the key characteristics of phantom limb sensation (PLS) and pain (PLP) in a current sample of Americans with limb loss.

METHODS

This cross-sectional study is the first large-scale (n=649) study on PLP in the current population of Americans with limb loss. A convenience sample of military and civilian persons missing one or more major limbs was surveyed regarding their health history and experience with phantom limb phenomena.

RESULTS

Of the participants surveyed, 87% experienced PLS and 82% experienced PLP. PLS and PLP typically first occurred immediately after amputation (47% of cases), but for a small percentage (3-4%) onset did not occur until over a year after amputation. Recent PLP severity decreased over time (β=0.028, 95% CI: -0.05-0.11), but most participants reported PLP even 10 years after amputation. Higher levels of recent PLP were associated with telescoping (β=0.123, 95% CI: 0.04-0.21) and higher levels of pre-amputation pain (β=0.104, 95% CI: 0.03-0.18). Those with congenitally missing limbs experienced lower levels of recent PLP (t (37.93)=3.93, p<0.01) but there were no consistent differences in PLP between other amputation etiologies.

CONCLUSIONS

Phantom limb phenomena are common and enduring. Telescoping and pre-amputation pain are associated with higher PLP. Persons with congenitally missing limbs experience lower levels of PLP than those with amputation(s), yet PLP is common even in this subpopulation.

Individualized Augmented Reality Training Reduces Phantom Pain and Cortical Reorganization in Amputees: A Proof of Concept Study

Phantom limb pain (PLP) may be relieved using a visual representation of an intact limb. However, patients with distorted (telescoped) phantoms seem unable to associate with visualizations of intact limbs. A virtual arm visualization was matched to the individual's phantom perception and controlled in an augmented reality (AR) intervention. Seven PLP participants with telescoped phantoms performed 8 supervised home-based AR-training sessions (45 minutes each) within 2 weeks. The virtual arm was superimposed in AR onto their residual limb and controlled using electromyography from the residual limb. AR-training sessions included 3 AR tasks aimed at reengaging the neural circuits related to the lost limb. Agency (Rubber hand illusion questionnaire) and telescoping (proprioceptive drift and felt telescoping) were monitored after individual training sessions. fMRI during lip pursing was assessed before and after intervention. Pain rating index scores were reduced by 52% (mean change = -1.884, P = .032, d = 1.135). Numerical rating scale scores of PLP severity (0-6) in patients benefitting from the intervention were reduced by 41% (mean change = .93 P = .022, d = 1.334). The lip pursing task illustrated decreased cortical activity in the primary somatosensory cortex, which correlated to the reduced numerical rating scale scores of PLP severity. PERSPECTIVE: Two weeks of novel AR interventions in patients with telescoped phantoms demonstrated reduced PLP and reversal of cortical reorganization. This research highlights the potential of individualized AR interventions for PLP and indicate the importance of agency in this type of treatments.

A general and atom-efficient continuous-flow approach to prepare amines, amides and imines via reactive N-chloramines

Chloramines are an important class of reagents, providing a convenient source of chlorine or electrophilic nitrogen. However, the instability of these compounds is a problem which makes their isolation and handling difficult. To overcome these hazards, a continuous-flow approach is reported which generates and immediately reacts N-chloramines directly, avoiding purification and isolation steps. 2-Chloramines were produced from the reaction of styrenes with N-alkyl-N-sulfonyl-N-chloramines, whilst N-alkyl or N,N'-dialkyl-N-chloramines reacted with anisaldehyde in the presence of t-BuO₂H oxidant to afford amides. Primary and secondary imines were produced under continuous conditions from the reaction of N-chloramines with base, with one example subsequently reduced under asymmetric conditions to produce a chiral amine in 94% ee.

Home-Based Tactile Discrimination Training Reduces Phantom Limb Pain

BACKGROUND

Phantom limb pain (PLP) affects a high percentage of amputees. Since treatment options are limited, low quality of life and addiction to pain medication frequently occur. New treatments, such as mirror therapy or electrical sensory discrimination training, make use of the brain's plasticity to alleviate this centrally derived pain.

AIM

This pilot study assessed the question of whether home-based tactile discrimination training (TDT) leads to a stronger decrease in PLP levels compared to standard massage treatment.

DESIGN

Controlled study.

SETTING

Outpatient.

POPULATION

Amputees (upper/lower extremity) with a PLP score of 4 or higher out of a possible 10 points on the visual analog scale.

METHODS

Eight patients participated in the study. The treatment phase comprised 2 weeks (15 minutes daily). Subjects were examined at baseline, after treatment, 2 weeks after completing treatment, and 4 weeks after completing treatment. Pain was assessed using the West Haven-Yale Multidimensional Pain Inventory.

RESULTS

There was a significantly stronger reduction in PLP in the treatment group receiving TDT. PLP intensity ratings were significantly reduced at the end of therapy, and at 2 and 4 weeks after completing treatment compared to pretreatment.

CONCLUSIONS

TDT seems to be an easy, cheap, time-effective, and safe method to achieve sustained alleviation of PLP and also brings about a positive change in body image.

REHABILITATION IMPACT

Home-based TDT could achieve a sustained reduction in PLP and should be considered as a possible alternative to established treatment methods.

Race and socioeconomic status in substance use progression and treatment entry

This study examined trajectories of progression from early substance use to treatment entry as a function of race, among inpatient treatment seekers (N = 945). Following primary race-contingent analyses of use progression, secondary analyses were conducted to investigate the effects of socioeconomic status (SES) on the observed differences. African Americans reported significant delays in treatment entry relative to Caucasians. Racial differences in alcohol, marijuana, and cocaine use trajectories were observed. Accounting for SES rendered observations of accelerated use among African Americans nonsignificant. However, inclusion of SES failed to mitigate the marked racial disparity in treatment entry.

Alcohol Consumption Milestones: Comparing First- Versus Last-Reported Age of Onset

Multiple assessments of age of onset of alcohol use milestones may produce inconsistent reports, yielding potentially different results, depending on the report utilized. Using data from a prospective study of 1,023 middle-school students, we modeled risk of onset of four drinking milestones as a function of multiple correlates of alcohol use and compared models using first versus last reported age for each milestone. . While forward telescoping was evident, no significant differences were obtained for any models examined. Substantive conclusions about associations of correlates of early drinking are not greatly impacted by misreporting age of first use.

The Fate of Childhood Memories: Children Postdated Their Earliest Memories as They Grew Older

Childhood amnesia has been attributed to the inaccessibility of early memories as children grow older. We propose that systematic biases in the age estimates of memories may play a role. A group of 4- to 9-year-olds children were followed for 8 years, recalling and dating their earliest childhood memories at three time points. Although children retained many of the memories over time, their age estimates of these memories shifted forward in time, to later ages. The magnitude of postdating was especially sizable for earlier memories and younger children such that some memories were dated more than a year later than originally. As a result, the boundary of childhood amnesia increased with age. These findings shed light on childhood amnesia and the fate of early memories. They further suggest that generally accepted estimates for people’s age of earliest memory may be wrong, which has far-reaching implications.

Telescoping and gender differences in the time course of disordered gambling: evidence from a general population sample

BACKGROUND AND AIM

The course of disordered gambling in women has been described as 'telescoped' compared with that in men, with a later age at initiation of gambling but shorter times from initiation to disorder. This study examined the evidence, for the first time, for such a telescoping effect in a general population rather than a treatment-seeking sample.

METHOD

Participants in a large community-based Australian twin cohort (2001 men, 2662 women) were assessed by structured diagnostic telephone interviews in which they reported the ages at which they had attained various gambling milestones and additional information to be used as covariates (the types of gambling in which they had participated and history of symptoms of alcohol dependence, major depression, and adult antisocial behavior). Cox proportional hazards regression models were used to examine differences between men and women in the time from gambling initiation to the first disordered gambling symptom and a diagnosis of disordered gambling.

RESULTS

Men had a higher hazards than women for the time to the first disordered gambling symptom [hazard ratio (HR) = 3.13, P < 0.0001] and to a diagnosis of disordered gambling (HR = 2.53, P < 0.0001). These differences persisted after controlling for covariates. Earlier age of initiation was the most potent predictor of progression to the first symptom.

CONCLUSIONS

When assessed at the general population level, female gamblers do not appear to show a telescoped disordered gambling trajectory compared with male gamblers.

Telescoping phenomenon in pathological gambling: association with gender and comorbidities

The course of pathological gambling (PG) in women has been described as having a later age of initiation but a shorter time to problematic gambling ("telescoped"). This study examined evidence for telescoping and its relationship with comorbidities. Seventy-one treatment-seeking individuals with PG underwent a diagnostic interview to examine gambling behaviors, age at initiation of gambling, and time from initiation to meeting criteria for PG. The women had a higher mean age at gambling initiation compared with that of the men (mean [SD] age, 31.3 [13.0] years, compared with 22.4 [7.9] years; p = 0.0003) and a significantly shorter time from initiation of gambling to meeting the criteria for PG (8.33 [8.7] years compared with 11.97 [9.1] years; p = 0.0476) after controlling for demographic and clinical variables. This study presents evidence for a gender-specific course of PG unrelated to psychiatric comorbidities and suggests a need for greater clinical focus on the gender differences of gambling behavior.

"Pulling telescoped phantoms out of the stump": manipulating the perceived position of phantom limbs using a full-body illusion

Most amputees experience phantom limbs, or the sensation that their amputated limb is still attached to the body. Phantom limbs can be perceived in the location previously occupied by the intact limb, or they can gradually retract inside the stump, a phenomenon referred to as “telescoping”.  Telescoping is relevant from a clinical point of view, as it tends to be related to increased levels of phantom pain. In the current study we demonstrate how a full-body illusion can be used to temporarily revoke telescoping sensations in upper limb amputees. During this illusion participants view the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking, which makes them experience the mannequin’s body as their own. In Experiment 1 we used an intact mannequin, and showed that amputees can experience ownership of an intact body as well as referral of touch from both hands of the mannequin. In Experiment 2 and 3 we used an amputated mannequin, and demonstrated that depending on the spatial location of the strokes applied to the mannequin, participants experienced their phantom hand to either remain telescoped, or to actually be located below the stump. The effects were supported by subjective data from questionnaires, as well as verbal reports of the perceived location of the phantom hand in a visual judgment task. These findings are of particular interest, as they show that the temporary revoking of telescoping sensations does not necessarily have to involve the visualization of an intact hand or illusory movement of the phantom (as in the rubber hand illusion or mirror visual feedback therapy), but that it can also be obtained through mere referral of touch from the stump to the spatial location corresponding to that previously occupied by the intact hand. Moreover, our study also provides preliminary evidence for the fact that these manipulations can have an effect on phantom pain sensations.

Telescoping of caregiver report on the Autism Diagnostic Interview--Revised

BACKGROUND

Delays in development are a fundamental feature in diagnosing autism spectrum disorders (ASD). Age of language acquisition, usually obtained through retrospective caregiver report, is currently used to distinguish between categories within ASD. Research has shown that caregivers often report children as having acquired developmental milestones earlier or later than they were actually achieved. The current study examines the extent to which this phenomenon, referred to as 'telescoping,' impacts retrospective reports provided by caregivers of children with ASD.

METHODS

Participants were 127 caregivers of children referred for possible ASD or non-spectrum developmental delay. Caregivers were interviewed when children were 2, 3, 5, and 9 years of age. Caregiver-reported ages of first concern, language and non-diagnostic developmental milestones and interviewer-estimated age of onset were compared over time using linear models.

RESULTS

Significant telescoping of language milestones resulted in more children meeting language delay criteria as they grew older, in spite of original reports that their language was not delayed. There was little evidence of consistent telescoping of caregiver-reported ages of first concern, daytime bladder control, and independent walking. With time, the interviewers' judged ages of symptom onset increased, but remained prior to age three.

CONCLUSIONS

Telescoping of caregiver-reported ages of language acquisition has implications for both clinical diagnosis and genetic studies using these milestones to increase homogeneity of samples. Results support proposals to remove specific age-based criteria in the diagnosis of ASD. Telescoping should be considered when working with any clinical population in which retrospectively recalled events are used in diagnosis.

Experimental induction of a perceived "telescoped" limb using a full-body illusion

Phantom limbs refer to the sensation that an amputated or missing limb is still attached to the body. Phantom limbs may be perceived as continuous with the stump so as to resemble a normal limb, or as “telescoped” with the more distal portion of the phantom being perceived as having withdrawn within the stump. Telescoping tends to be related to increased levels of phantom pain, making it a clinically relevant phenomenon to investigate. In the current study we show that a full-body illusion can be used to induce the sensation of a telescoped limb in healthy individuals. For the induction of the full-body illusion, participants saw the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking. Crucially, the mannequin was missing its left hand so as to resemble an amputee. By manipulating the positioning of the strokes applied to the mannequin's stump with respect to the participants’ hand we were able to evoke the sensation of the participants’ hand being located either below the stump or, more crucially, “inside” the stump, i.e., telescoped. In three separate experiments these effects were supported by complementary subjective data from questionnaires, verbally reported perceived location of the hand, and manual pointing movements indicating hand position (proprioceptive drift). Taken together our results show that healthy individuals can experience the body of an upper limb amputee as their own, and that this can be associated with telescoping sensations. This is a theoretically important observation as it shows that ownership of an entire body can be evoked in the context of gross anatomical incongruence for a single limb, and that telescoping sensations occur as a consequence of the body representation system trying to reduce this incongruence. Furthermore, the present study might provide a new platform for future studies of the relationship between telescoping and phantom pain in amputees.

Telescoped trajectories from alcohol initiation to disorder in children of alcoholic parents

The current study tested whether and why children of alcoholics (COAs) showed telescoped (adolescent) drinking initiation-to-disorder trajectories as compared with non-COAs. Using longitudinal data from a community-based sample, the authors confirmed through survival analyses that COAs progressed more quickly from initial adolescent alcohol use to the onset of disorder than do matched controls. Similar risks for telescoping were evident in COAs whose parents were actively symptomatic versus those whose parents had been previously diagnosed. Stronger telescoping effects were observed for COAs whose parents showed comorbidity for either depression or antisocial personality disorder. Both greater externalizing symptoms and more frequent, heavier drinking patterns at initiation failed to explain COAs' risk for telescoping, although externalizing symptoms were a unique predictor of telescoping. This risk for telescoping was also evident for drug disorders. These findings characterize a risky course of drinking in COAs and raise important questions concerning the underlying mechanisms and consequences of telescoping in COAs.