The validity, reliability, and protocol for the interpolated twitch technique (ITT) were investigated with isometric plantar flexor and leg extension contractions. Estimates of muscle inactivation were attempted by comparing a variety of superimposed with potentiated evoked torques with submaximal and maximal voluntary contraction (MVC) torques or forces. The use of nerve and surface stimulation to elicit ITT was reliable, except for problems in maintaining maximal stimulation with nerve stimulation at 20 degrees plantar flexion and during leg extension. The interpolated twitch ratio-force relationship was best described by a shallow hyperbolic curve resulting in insignificant MVC prediction errors with second-order polynomials (1.1-6.9%). The prediction error under 40% MVC was approximately double that over 60% MVC, contributing to poor estimations of MVC in non-weight-bearing postimmobilized ankle fracture patients. There was no significant difference in the ITT sensitivity when twitches, doublets, or quintuplets were used. The ITT was valid and reliable when high-intensity contractions were analyzed with a second-order polynomial.

Introduction The aim of this study was to develop a reliable objective structured assessment of technical skills (OSATS) score for linear-stapled, hand-sewn closure of enterotomy intestinal anastomoses (A-OSATS). Materials and methods The Delphi methodology was used to create a traditional and weighted A-OSATS score highlighting the more important steps for patient outcomes according to an international expert consensus. Minimally invasive novices, intermediates, and experts were asked to perform a minimally invasive linear-stapled intestinal anastomosis with hand-sewn closure of the enterotomy in a live animal model either laparoscopically or robot-assisted. Video recordings were scored by two blinded raters assessing intrarater and interrater reliability and discriminative abilities between novices (n = 8), intermediates (n = 24), and experts (n = 8). Results The Delphi process included 18 international experts and was successfully completed after 4 rounds. A total of 4 relevant main steps as well as 15 substeps were identified and a definition of each substep was provided. A maximum of 75 points could be reached in the unweighted A-OSATS score and 170 points in the weighted A-OSATS score respectively. A total of 41 anastomoses were evaluated. Excellent intrarater (r = 0.807–0.988, p < 0.001) and interrater (intraclass correlation coefficient = 0.923–0.924, p < 0.001) reliability was demonstrated. Both versions of the A-OSATS correlated well with the general OSATS and discriminated between novices, intermediates, and experts defined by their OSATS global rating scale. Conclusion With the weighted and unweighted A-OSATS score, we propose a new reliable standard to assess the creation of minimally invasive linear-stapled, hand-sewn anastomoses based on an international expert consensus. Validity evidence in live animal models is provided in this study. Future research should focus on assessing whether the weighted A-OSATS exceeds the predictive capabilities of patient outcomes of the unweighted A-OSATS and provide further validity evidence on using the score on different anastomotic techniques in humans.

Transient decrease in the excitability of a reflex circuit following its activation by appropriate stimuli is a well-recognized phenomenon, but it is unclear how this applies to thermoalgesic stimuli during quantitative sensory testing (QST). We examined the effects induced by a thermoalgesic (conditioning) stimulus on the response to a subsequent (test) stimulus of the same characteristics. All tests were done using a Peltier thermode with a surface area of 12.5 cm(2) using ramp rates of 2 degrees C/s and variable interstimulus intervals (ISIs) ranging from 10 to 60 s. Perception was measured with an electronic visual analog scale. No changes were observed in latency of pain perception. However, latency of warm perception was significantly delayed and pain perception intensity was significantly reduced with respect to conditioning stimuli at ISIs below 60 s. Our results indicate a transient saturation of warm and heat pain perception systems after a thermoalgesic stimulus. We therefore recommend that time intervals of >1 min be used between two consecutive thermoalgesic stimuli when examining QST.

Introduction: Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of neoplasms. Surgery is the only curative treatment option. However, our understanding of predictors of survival after surgery remains incomplete. The aim of the study was to evaluate metabolic syndrome (MetS) as a prognostic factor in pNET. Methods: In a retrospective single centre cohort study, we examined the influence of MetS in 120 patients with curative intended resection of pNETs on overall survival (OS), recurrence free survival (RFS) and outcome after recurrence. Results: MetS was present in 32 patients (26.6%). Patients with MetS had an impaired OS after curative intended surgery compared to patients without MetS (median OS 72 months (95% CI 13.3-130.7) vs not reached, p<0,001). The shortest survival was observed in patients with MetS in the presence of oligo-metastatic disease at time of surgery. In a multivariable Cox regression analysis MetS was identified as an independent risk factor for mortality (HR= 4.54 (95% CI (1.88- 11.00), p= 0.01). In our dataset, MetS was not associated with tumor recurrence or recurrence free survival. Nevertheless, in patients with recurrence, MetS was associated with shorter time to recurrence (median 3.4 months (95% CI (2.48-4.24) vs 20.1 months (95% CI (10.8-29.49), p<0.001), and poor outcome (HR=5.03 (95% CI (1.25-20.20), p= 0.01). Conclusions: We identified MetS as a negative prognostic factor after curative intended surgery for pNET. In particular, patients with oligo-metastatic disease might not benefit from extensive surgery in the presence of MetS. Furthermore, MetS had a strong impact on survival after recurrence.