Referred shoulder pain (C4 dermatome) can adversely impact diaphragm pacing with intramuscular electrodes
Bibliographic record
Abstract
Diaphragm pacing is an alternative to mechanical ventilation in patients with high cervical cord damage (>C4 dermatome). It brings clinical benefits and reduces health costs [1–3]. It is also indicated in certain cases of central hypoventilation [4]. Two types of diaphragm pacing devices are commercially available. With intrathoracic phrenic stimulation, electrodes are implanted around the phrenic nerves in the thorax (Avery Biomedical, Commack, NY, USA; and Atrotech, Tampere, Finland). Nerve dissection during a video-assisted mini-thoracotomy allows intimate contact of the stimulating electrodes with the nerve [5]. Stimulating currents typically range between 0.3–3.5 mA [6]. With intradiaphragmatic stimulation, hook wire electrodes are laparoscopically implanted in the diaphragm in the vicinity of the phrenic nerve termination (Synapse Biomedical, USA) [in 5]. Stimulating currents typically range between 5–20 mA. In quadriplegic patients, intradiaphragmatic phrenic stimulation is effective [7] and has been advocated as easier to implement and less expensive than its intrathoracic counterpart [5]. In patients who retain spontaneous diaphragm activity, this approach is appealing because it is devoid of the theoretical risk of procedure-induced phrenic nerve damage associated with the intrathoracic route. For these reasons, we implanted intradiaphragmatic phrenic stimulators in four hypoventilation patients after the device was authorised in France in 2010. In France, both intrathoracic and intradiaphragmatic diaphragm pacing are authorised and reimbursed by social security in quadriplegia and central hypoventilation and are managed at a single multidisciplinary centre nationwide. Diaphragm pacing with intramuscular electrodes causes pain in central hypoventilation patients without spinal lesions The authors are grateful to Paul Robinson for editing English style and grammar.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".