Pre-habilitation before colorectal cancer surgery could improve postoperative gastrointestinal function recovery: a case-matched study

PURPOSE

While its effect is controverted, multimodal pre-habilitation could be used to improve the postoperative course following colorectal cancer surgery. However, by increasing lean body mass, pre-habilitation could reduce the time needed to recover gastrointestinal (GI) functions. The aim was to assess the impact of pre-habilitation before colorectal cancer surgery on postoperative GI motility recovery.

METHODS

This is a matched retrospective study based on a prospective database including patients undergoing colorectal surgery without pre-habilitation (NPH) (2016-2018) and with pre-habilitation (PH group) (2018-2019). The main outcome measure was the time to GI-3 recovery (tolerance to solid food and flatus and/or stools).

RESULTS

One hundred thirteen patients were included, 37 underwent pre-habilitation (32.7%). The patient's age, the surgical procedure, the surgical access, the rate of synchronous metastasis, the rate of preoperative chemoradiotherapy, and the rate of stoma were more important in the PH group. Conversely, the rate of patients with an ASA score of > 2 was higher in the NPH group. By matching patients according to age, gender and surgical procedure, 84 patients were compared (61 in the NPH group and 23 in the PH group). The mean of GI-3 recovery was significantly lower in the PH group. The other endpoints were not significantly different but time to GI function recovery and medical morbidity tended to be higher in the NPH group. Compliance with the enhanced recovery program was significantly higher in the PH group.

CONCLUSION

Pre-habilitation before colorectal cancer surgery reduced time to GI function recovery and may increase compliance with the enhanced recovery program.

Patch-based 3D U-Net and transfer learning for longitudinal piglet brain segmentation on MRI

BACKGROUND AND OBJECTIVES

In order to study neural plasticity in immature brain following early brain lesion, large animal model are needed. Because of its morphological similarities with the human developmental brain, piglet is a suitable but little used one. Its study from Magnetic Resonance Imaging (MRI) requires the development of automatic algorithms for the segmentation of the different structures and tissues. A crucial preliminary step consists in automatically segmenting the brain.

METHODS

We propose a fully automatic brain segmentation method applied to piglets by combining a 3D patch-based U-Net and a post-processing pipeline for spatial regularization and elimination of false positives. Our approach also integrates a transfer-learning strategy for managing an automated longitudinal monitoring evaluated for four developmental stages (2, 6, 10 and 18 weeks), facing the issue of MRI changes resulting from the rapid brain development. It is compared to a 2D approach and the Brain Extraction Tool (BET) as well as techniques adapted to other animals (rodents, macaques). The influence of training patches size and distribution is studied as well as the benefits of spatial regularization.

RESULTS

Results show that our approach is efficient in terms of average Dice score (0.952) and Hausdorff distance (8.51), outperforming the use of a 2D U-Net (Dice: 0.919, Hausdorff distance: 11.06) and BET (Dice: 0.764, Hausdorff distance: 25.91). The transfer-learning strategy achieves a good performance on older piglets (Dice of 0.934 at 6 weeks, 0.956 at 10 weeks and 0.958 at 18 weeks) compared to a standard training strategy with few data (Dice of 0.636 at 6 weeks, 0.907 at 10 weeks, not calculable at 18 weeks because of too few training piglets).

CONCLUSIONS

In conclusion, we provide a method for longitudinal MRI piglet brain segmentation based on 3D U-Net and transfer learning which can be used for future morphometric studies and applied to other animals.

Functional, neuroplastic and biomechanical changes induced by early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (e-HABIT-ILE) in pre-school children with unilateral cerebral palsy: study protocol of a randomized control trial

BACKGROUND

Cerebral palsy (CP) causes motor, cognitive and sensory impairment at different extents. Many recent rehabilitation developments (therapies) have focused solely on the upper extremities (UE), although the lower extremities (LE) are commonly affected. Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) applies the concepts of motor skill learning and intensive training to both the UE and LE. It involves constant stimulation of the UE and LE, for several hours each day over a 2-week period. The effects of HABIT-ILE have never been evaluated in a large sample of young children. Furthermore, understanding of functional, neuroplastic and biomechanical changes in infants with CP is lacking. The aim of this study is to carry out a multi-center randomized controlled trial (RCT) to evaluate the effects of HABIT-ILE in pre-school children with unilateral CP on functional, neuroplastic and biomechanical parameters.

METHODS

This multi-center, 3-country study will include 50 pre-school children with CP aged 1-4 years. The RCT will compare the effect of 50 h (two weeks) of HABIT-ILE versus usual motor activity, including regular rehabilitation. HABIT-ILE will be delivered in a day-camp setting, with structured activities and functional tasks that will be continuously progressed in terms of difficulty. Assessments will be performed at 3 intervals: baseline (T0), two weeks later and 3 months later. Primary outcomes will be the Assisting Hand Assessment; secondary outcomes include the Melbourne Assessment-2, executive function assessments, questionnaires ACTIVLIM-CP, Pediatric Evaluation of Disability Inventory, Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, as well as neuroimaging and kinematics measures.

DISCUSSION

We expect that HABIT-ILE will induce functional, neuroplastic and biomechanical changes as a result of the intense, activity-based rehabilitation process and these changes will impact the whole developmental curve of each child, improving functional ability, activity and participation in the short-, mid- and long-term. Name of the registry: Changes Induced by Early HABIT-ILE in Pre-school Children With Uni- and Bilateral Cerebral Palsy (EarlyHABIT-ILE).

TRIAL REGISTRATION

Trial registration number: NCT04020354-Registration date on the International Clinical Trials Registry Platform (ICTRP): November 20th, 2018; Registration date on NIH Clinical Trials Registry: July 16th, 2019.

Global Perturbation of Initial Geometry in a Biomechanical Model of Cortical Morphogenesis

Cortical folding pattern is a main characteristic of the geometry of the human brain which is formed by gyri (ridges) and sulci (grooves). Several biological hypotheses have suggested different mechanisms that attempt to explain the development of cortical folding and its abnormal evolutions. Based on these hypotheses, biomechanical models of cortical folding have been proposed. In this work, we compare biomechanical simulations for several initial conditions by using an adaptive spherical parameterization approach. Our approach allows us to study and explore one of the most potential sources of reproducible cortical folding pattern: the specification of initial geometry of the brain.

Laparoscopic adjustable gastric banding in adolescents with severe obesity: Psychological aspects, decision makers of surgery, and 2-year outcomes. A case series

BACKGROUND

The results of medical treatment of severe obesity in the adolescent population (balanced diet and physical activity) are often unsatisfactory, and bariatric surgery is questioned. The psychological determinants for requesting bariatric surgery in these adolescents are unclear. The objective of this study was to report the psychiatric and psychological aspects as well as the determinants of the medical decision for surgery in a cohort of obese adolescents requesting bariatric surgery by laparoscopic adjustable gastric banding.

METHODS

Thirty-five adolescents (12.3-17.7 years of age), were recruited from January 2007 to December 2012. Semistructured interviews were conducted.

RESULTS

Fifty-four percent of the adolescents had a psychiatric history and 85% had psychiatric comorbidities. In adolescents undergoing surgery, excess weight loss was 46% after 1 year and 51% after 2years. For patients not receiving surgery, excess weight loss was 0.43% after 1 year (P=0.001). Compliance with medical treatment was the only significant element contributing to the decision to perform surgery. Results in terms of satisfaction and perception 1 and 2years after surgery were encouraging.

CONCLUSION

Bariatric surgery is feasible in young patients and produces good results in terms of excess weight loss. We argue that compliance with medical treatment is probably one of the most important elements for making the decision to perform bariatric surgery and in excess weight loss after surgery. We probably need to focus on the compliance of young patients and evaluate how this can be improved.

Vitamin D and the Mechanisms, Circumstances and Consequences of Falls in Older Adults: A Case-Control Study

OBJECTIVES

To determine i) whether cases of elderly fallers had lower serum 25-hydroxyvitamin D (25OHD) concentration than controls without history of falls; and ii) whether serum 25OHD concentration was associated with specific mechanisms, circumstances and consequences of falls.

DESIGN

Case-control study with a 1:2 ratio.

SETTING

Geriatric ward of the University Hospital of Angers, France, between February 2012 and March 2014.

PARTICIPANTS

216 inpatients (72 cases and 144 age- and gender-matched controls).

MEASUREMENT

Falls were defined as involuntary events causing the person to the ground or other lower level. The main mechanisms, circumstances and consequences of falls were identified using standardized questionnaires. Vitamin D deficiency was defined as serum 25OHD concentration ≤25nmol/L. Age, gender, body mass index, polypharmacy, use antihypertensive drugs, use psychoactive drugs, disability, cognitive performance, serum concentrations of parathyroid hormone, creatinine and albumin, and season of evaluation were used as potential confounders.

RESULTS

216 participants (72 cases and 144 controls) were included in the study. There was no between-group difference in the prevalence of vitamin D deficiency (P=0.176). After adjusting for confounding factors, vitamin D deficiency was positively associated with falls (OR=4.03, P=0.014). Finally, the fallers with vitamin D deficiency exhibited more often orthostatic hypotension (68.8% against 33.3%, P=0.039) and a history of recurrent falls (85% against 50%, P=0.002) than those without vitamin D deficiency.

CONCLUSION

This case-control study reported that vitamin D deficiency was associated with falls in older inpatients. There was a greater prevalence of orthostatic hypotension and of the reccurrence of falls among fallers with vitamin D deficiency, suggesting that vitamin D may influence the conditions predisposing to falls rather than the fall by itself.

Perspectives in neonatal and childhood arterial ischemic stroke

INTRODUCTION

Over the last decade considerable advances have been made in the identification, understanding and management of pediatric arterial ischemic stroke. Such increasing knowledge has also brought new perspectives and interrogations in the current acute and rehabilitative care of these patients. Areas covered: In developed countries, focal cerebral arteriopathy is one of the most common causes of arterial ischemic stroke in childhood and imaging features are well characterized. However, there are ongoing debates regarding its underlying mechanisms, natural evolution and proper management. The implementation of thrombolytic therapy in acute pediatric stroke has been shown to be efficient in anecdotal cases but is still limited by a number of caveats, even in large tertiary centers. Finally, neonatal stroke represents a unique circumstance of possible early intervention before the onset of any neurological disability but this appears meaningful only in a selective group of neonates. Expert commentary: While perinatal stroke, a leading cause of cerebral palsy, appears to be multifactorial, a large number of childhood ischemic stroke are probably essentially triggered by infectious factors leading to vessel wall damage. Current research is aiming at better identifying risk factors in both conditions, and to define optimal acute and preventive therapeutic strategies in order to reduce significant long-term morbidity.

Pain during injections of botulinum toxin in children: Influence of the localization technique

OBJECTIVE

In this study, we consider two localization techniques used in injections of botulinium toxin in children: electrical stimulation and ultrasound. The hypothesis of this work was that injections performed without stimulation would be less painful.

PATIENTS AND METHODS

Monocentric prospective study, with 107 sessions of lower limb injections. Two groups of children were compared: localization by ultrasound only (60 children), detection by stimulation only or by stimulation combined with ultrasound (47 children). Pain assessment was performed by the child or an accompanying party using the Visual Analog Scale (VAS) and by a health care team using the Face, Legs, Activity, Cry, Consolability (FLACC).

RESULTS

A significant difference between the two groups was found in both self-report and by means of the behavioral observational pain scale. Indeed, VAS average and FLACC average were significantly higher with detection by stimulation than with ultrasound alone: 4.5cm±2.54 versus 2.7cm±2.27; P<0.001 for VAS scale and 3.7±2.1 versus 2.7±2.3; P<0.05 for FLACC scale.

CONCLUSION

When compared to ultrasound detection, localization by electrostimulation appears to increase the overall pain caused during injections of botulinum toxin in children.

Quality of life and functional outcome in early school-aged children after neonatal stroke: a prospective cohort study

BACKGROUND

Quality of life (QoL) is recognized internationally as an efficient tool for evaluating health interventions. To our knowledge, QoL has not been specifically assessed in children after neonatal arterial ischemic stroke (AIS).

AIM

To study the QoL of early school-aged children who suffered from neonatal AIS, and QoL correlation to functional outcome.

METHOD

We conducted a multicenter prospective cohort study as part of a larger study in full-term newborns with symptomatic AIS. Participating families were sent anonymous QoL questionnaires (QUALIN). Functional outcome was measured using the Wee-FIM scale. Healthy controls in the same age range were recruited in public schools. Their primary caregivers filled in the QUALIN questionnaires anonymously. We used Student's t-test and a rank test to compare patients and controls' QoL and functional outcomes.

RESULTS

84 children with neonatal AIS were included. The control group was composed of 74 children, of which ten were later excluded due to chronic conditions. Mean ages and QUALIN median scores did not differ between patients and controls. Median Wee-FIM scores were lower in hemiplegic children than in non-hemiplegic ones (p < 0.001). QoL scores did not seem correlated to functional outcome.

INTERPRETATION

Those results could support the presence of a "disability paradox" in young children following neonatal AIS.

Social functioning and self-esteem in young people with disabilities participating in adapted competitive sport

AIMS

The aim of this study was to investigate social functioning quality of life and self-esteem in young people with disabilities taking part in adapted competitive sport.

METHOD

A sample of 496 athletes (mean age 16 years 4 months, range: 9 years to 20 years 9 months) was obtained from the 540 participants (91.8%) involved in a French national championship. The main outcome measurements were a social functioning inventory (PedsQL 4.0 social functioning) and a self-esteem inventory in physical areas (physical self inventory 6 PSI-6).

RESULTS

The mean PedsQL SF score was 74.6 (SD: 17.7). Comparisons of PedsQL SF according to gender, age, self mobility and training revealed no significant differences between the groups. PedsQL SF was weakly but significantly correlated with all subscales of the PSI-6 in the total population. PSI-6 scores were significantly different between boys and girls, with better self-esteem for boys on general self-esteem (7.7 vs. 6.9, P=0.018), physical condition (6.8 vs. 6.0, P=0.023) and attractive body subscores (6.5 vs. 5.1, P<0.001).

CONCLUSION

Social functioning scores were significantly higher in this population than in the samples of young people with disabilities available in the literature. Interactions between self-concept, social functioning quality of life and participation in adapted sport activities require further studies.