Kejia Hu

Barriers in palliative care in China

1272 www.thelancet.com Vol 387 March 26, 2016 widely used veterinary anaesthetic. As in human medicine, ketamine is essential in LMICs; in high-income countries, this drug is now virtually the only injectable anaesthetic used in horses and is widely used in small animal clinics for high-risk cases and exotic species. The side-eff ects of bladder damage from chronic ketamine misuse are horrifi c, but this aff ects only a few who take very high doses; most recreational users have few ill eff ects. Recreational use of ketamine should not prevent millions of people from surgery under the only anaesthetic in LMICs, or its use in disaster and confl ict trauma, and in veterinary medicine. Let us support WHO’s analysis that the medical benefits of ketamine far outweigh potential harm from recreational use.

Intraindividual comparison between open and endoscopic release in bilateral carpal tunnel syndrome: a meta-analysis of randomized controlled trials

This study evaluated functional outcomes and safety after endoscopic and open bilateral carpal tunnel syndrome release in opposite hands of the same patients through a meta‐analysis of randomized controlled trial data.

Scientific profile of brain–computer interfaces: Bibliometric analysis in a 10-year period

BACKGROUND With the tremendous advances in the field of brain-computer interfaces (BCI), the literature in this field has grown exponentially; examination of highly cited articles is a tool that can help identify outstanding scientific studies and landmark papers. This study examined the characteristics of 100 highly cited BCI papers over the past 10 years. METHODS The Web of Science was searched for highly cited papers related to BCI research published from 2006 to 2015. The top 100 highly cited articles were identified. The number of citations and countries, and the corresponding institutions, year of publication, study design, and research area were noted and analyzed. RESULTS The 100 highly cited articles had a mean of 137.1(SE: 15.38) citations. These articles were published in 45 high-impact journals, and mostly in TRANSACTIONS ON BIOMEDICAL ENGINEERING (n=14). Of the 100 articles, 72 were original articles and the rest were review articles. These articles came from 15 countries, with the USA contributing most of the highly cited articles (n=52). Fifty-seven institutions produced these 100 highly cited articles, led by Duke University (n=7). CONCLUSIONS This study provides a historical perspective on the progress in the field of BCI, allows recognition of the most influential reports, and provides useful information that can indicate areas requiring further investigation.

Efficacy of prophylactic probiotics in combination with antibiotics versus antibiotics alone for colorectal surgery: A meta-analysis of randomized controlled trials

This meta‐analysis aimed to determine whether prophylactic probiotics in combination with antibiotics are superior to antibiotics alone in the prevention of surgical site infection (SSI) after colorectal surgery. Fourteen trials involving 1524 participants were included. Compared with antibiotics alone, prophylactic probiotics in combination with antibiotics reduced the risk of SSI as well as other complications, shortened the cumulative duration of antibiotic therapy. Current evidence suggested that probiotics in combination with antibiotics could be recommended.

Editorial. Advancement in brain–machine interfaces for patients with tetraplegia: neurosurgical perspective

TeTraplegia results in the loss of motor function of all limbs and torso. It can affect basic motor function, sensation, respiration, digestion, bladder control, and other core autonomic functions.48 The most common cause of tetraplegia is spinal cord injury (SCI). It can also be caused by neuromuscular disorders such as amyotrophic lateral sclerosis (ALS).28,37 Although extensive efforts have been devoted to restoring damaged neural pathways following SCI, including physical rehabilitation,16,30 neuromodulation therapies,3 surgical procedures,4 and regenerative medicine,9,29,35 there currently remain few effective options for the restoration of motor or sensory function in individuals with tetraplegia. Intracranial brain–machine interfaces (iBMIs), also known as intracranial brain–computer interfaces, are based on multidisciplinary approaches that combine neurophysiology, computer science, and bioengineering. Their principal aim is to restore motor and/or sensory capacities. Brain–machine interfaces use neural activity recorded from the brain to decode the motor intent of an individual in real time and, based on this, artificially produce the desired limb movement.33,42 Therefore, to obtain neuronal recordings, either through microelectrodes or electrocorticographic (ECoG) grids, iBMI intrinsically requires neurosurgical access to functionally defined brain areas.5 Although most of these approaches have been tested in animal models, more recent studies have demonstrated the prospective use of iBMI technology in human patients with SCI.19 The rapid development and significant research efforts in this field suggest a more prominent role of iBMI in restorative neurosurgery.

Bibliometric profile of deep brain stimulation

Abstract Objective: We aimed to identify and analyze the characteristics of the 100 most highly-cited papers in the research field of deep brain stimulation (DBS). Methods: The Web of Science was searched for highly-cited papers related to DBS research. The number of citations, countries, institutions of origin, year of publication, and research area were noted and analyzed. Results: The 100 most highly-cited articles had a mean of 304.15 citations. These accrued an average of 25.39 citations a year. The most represented target by far was the subthalamic nucleus (STN). These articles were published in 46 high-impact journals, with Brain (n = 10) topping the list. These articles came from 11 countries, with the USA contributing the most highly-cited articles (n = 29); however, it was the University of Toronto (n = 13) in Canada that was the institution with the most highly-cited studies. Conclusions: This study identified the 100 most highly-cited studies and highlighted a historical perspective on the progress in the field of DBS. These findings allow for the recognition of the most influential reports and provide useful information that can indicate areas requiring further investigation.

Decoding unconstrained arm movements in primates using high-density electrocorticography signals for brain-machine interface use

Motor deficit is among the most debilitating aspects of injury to the central nervous system. Despite ongoing progress in brain-machine interface (BMI) development and in the functional electrical stimulation of muscles and nerves, little is understood about how neural signals in the brain may be used to potentially control movement in one’s own unconstrained paralyzed limb. We recorded from high-density electrocorticography (ECoG) electrode arrays in the ventral premotor cortex (PMv) of a rhesus macaque and used real-time motion tracking techniques to correlate spatial-temporal changes in neural activity with arm movements made towards objects in three-dimensional space at millisecond precision. We found that neural activity from a small number of electrodes within the PMv can be used to accurately predict reach-return movement onset and directionality. Also, whereas higher gamma frequency field activity was more predictive about movement direction during performance, mid-band (beta and low gamma) activity was more predictive of movement prior to onset. We speculate these dual spatiotemporal signals may be used to optimize both planning and execution of movement during natural reaching, with prospective relevance to the future development of neural prosthetics aimed at restoring motor control over one’s own paralyzed limb.

Brachialis muscle transfer for reconstructing digital flexion after brachial plexus injury or forearm injury

Restoration of digital flexion after brachial plexus injury or forearm injury has been a great challenge for hand surgeons. Nerve transfer and forearm donor muscle transfer surgeries are not always feasible. The present study aimed at evaluating the effectiveness of restoring digital flexion by brachialis muscle transfer. Ten lower brachial plexus- or forearm-injured patients were enrolled. After at least 12 months following surgery, the middle-finger-to-palm distance was less than 2.5 cm in six patients. In the other four patients with less satisfactory results, secondary tenolysis surgery was performed and the middle-finger-to-palm distances were reduced to 2.0–4.0 cm. The average grasp strength was 20 ± 4 kg. Elbow flexion was not adversely affected. In conclusion, brachialis muscle transfer is an effective method for reconstructing digital flexion, not only in lower brachial plexus injury, but also in forearm injury patients. Level of evidence: IV

Plexiform neurofibroma as a cause of carpal tunnel syndrome in a radial deficiency patient

Abstract We reported a rare peripheral nerve case, a patient developed carpal tunnel syndrome with a history of floating thumb in right hand. The median nerve was found expanded and spindle-shaped and a plexiform neurofibroma was diagnosed. Our case sheds light on anatomy and possible etiological association which may help clinical management.

Multisite licence to practise medicine in China

1 China national health and family planning commission. Doctors’ multi-sited licensed practice needs a written consent of the original hospital (in Chinese). http://news.xinhuanet. com/politics/2014-01/27/c_119154806.htm (accessed March 30, 2014). 2 The Lancet. Violence against doctors: Why China? Why now? What next? Lancet 2014; 383: 1013. been killed by their patients, which is unprecedented worldwide. In addition to medical graduates quitting the profession because of increased violence, the number of Chinese medical school applicants has decreased greatly in recent years. A survey done by the Chinese medical doctor association showed that only 6·83% of doctors would advise their children to choose this career. Even in the best medical schools, only a few applicants reach the required score line (eg, only 4 for Peking Union Medical College, the lowest number since the advent of China’s college entrance examination, in Guangdong Province in 2010). Meanwhile, the national admission score for a graduate student majoring in medicine has also declined for 3 consecutive years, according to the Chinese Ministry of Education. It is no longer the best students who go to medical school. This is a growing concern: who will be tomorrow’s doctors? A thorough health-care reform should be given high priority to restore the doctor–patient relationship and prevent a shortage of medical workers.