bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-Reported Outcome Measures for Hand and Wrist Trauma
Authors: Dacombe Peter Jonathan , Amirfeyz Rouin , Davis Tim
Published: May 2016

Background: Patient-reported outcome measures (PROMs) are important tools for assessing outcomes following injuries to the hand and wrist. Many commonly used PROMs have no evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. This systematic review examines the PROMs used in the assessment of hand and wrist trauma patients, and the evidence for reliability, validity, and responsiveness of each measure in this population. Methods: A systematic review of Pubmed, Medline, and CINAHL searching for randomized controlled trials of patients with traumatic injuries to the hand and wrist was carried out to identify the PROMs. For each identified PROM, evidence of reliability, validity, and responsiveness was identified using a further systematic review of the Pubmed, Medline, CINAHL, and reverse citation trail audit procedure. Results: The PROM used most often was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; the Patient-Rated Wrist Evaluation (PRWE), Gartland and Werley score, Michigan Hand Outcomes score, Mayo Wrist Score, and Short Form 36 were also commonly used. Only the DASH and PRWE have evidence of reliability, validity, and responsiveness in patients with traumatic injuries to the hand and wrist; other measures either have incomplete evidence or evidence gathered in a nontraumatic population. Conclusions: The DASH and PRWE both have evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. Other PROMs used to assess hand and wrist trauma patients do not. This should be considered when selecting a PROM for patients with traumatic hand and wrist pathology.
Proximal Interphalangeal Joint Extension Block Splint
Authors: Abboudi Jack , Jones Christopher M.
Published: May 2016

Background: Extension block splinting of the proximal interphalangeal (PIP) joint is a simple and useful treatment option although the practical application of this technique has remained undefined in the literature. Methods: This article provides a step-by-step technique for the construction of a reliable PIP extension block splint and also reviews basic indications for treatment with a PIP extension block splint as well as other PIP extension block splint designs. Results: The proposed splint design outlined in this article is reliable, easy to reproduce and easy for patients to manage when treated with a PIP extension block splint. Conclusions: PIP extension block splinting has a role for certain injuries and certain post-operative protocols. A reliable splint design that is easy to manage makes this treatment choice more attractive to the surgeon and the patient.
Functional Fusion Angle for Thumb Interphalangeal Joint Arthrodesis
Authors: McGowan Shane , Deisher Mirella , Matullo Kristofer S.
Published: May 2016

Background: A thumb interphalangeal (IP) joint arthrodesis is typically performed in 0° to 30° of flexion; most daily activities involve increased flexion at the IP joint to facilitate pinch and grip. This study evaluates the preferred thumb IP joint position with certain tasks of daily living to determine a more satisfactory angle. Methods: Twenty-eight healthy volunteers were splinted at various degrees (0°, 15°, 30°, 45°, bilaterally) with thumb orthotics, leaving the tip free, to mimic various angles of IP fusion. Participants underwent power tasks (pouring from a gallon jug, opening/closing a tight jar, lifting a heavy glass, and opening a door), timed precision tasks (writing, buttoning/unbuttoning a shirt, translating coins, zipping/unzipping a jacket, and opening/closing Velcro), as well as pinch and grip strength testing. All tasks were performed both at baseline (without any splinting) and with the thumb splinted in each angle. Participants used a 10-point Visual Analogue Scale (VAS) to rate the ease of each task as well as their overall satisfaction at baseline and at each of the various angles for their dominant and nondominant hand. Wilcoxon signed rank tests were conducted for outcomes, with P < .05 denoting statistical significance. Results: Power tasks were best accomplished at 0° for the nondominant hand and 0° to 30° for the dominant hand. Precision tasks were preferred at 15° for both dominant and nondominant hand. Grip strength was best at 15° and 0° for the nondominant and dominant hand, respectively. Pinch was equivocal between 0° and 30° for the nondominant hand and from 15° to 30° for the dominant hand. VAS ratings were most similar to baseline at a fusion angle of 15° followed by 30° for the dominant thumb and 30° followed by 15° for the nondominant thumb. Conclusions: A thumb IP fusion angle of 15° to 30° is a functional and preferred angle of thumb IP joint positioning for various activities of daily living.
Endoscopic Versus Open Cubital Tunnel Release
Authors: Aldekhayel Salah , Govshievich Alexander , Lee James , Tahiri Youssef , Luc Mario
Published: May 2016

Background: Several surgical techniques exist for treatment of cubital tunnel syndrome. Endoscopic cubital tunnel release (ECTuR) has been recently reported as a promising minimally invasive technique. This study aims to compare outcomes and complications of open cubital tunnel release (OCTuR) and ECTuR in the treatment of idiopathic cubital tunnel syndrome. Methods: A systematic review of the literature (1980-2014) identified 118 citations. Studies including adults with idiopathic cubital tunnel treated exclusively by ECTuR or OCTuR were included. Outcomes of interest were postoperative grading, complications, number of reoperations, and the need for intraoperative conversion to another technique. Postoperative outcomes were combined into a uniform scale with 4 categories: “excellent,” “good,” “fair,” and “poor.” Results: Twenty studies met the inclusion criteria (17 observational and 3 comparative), representing 425 open and 556 endoscopic decompressions. In the open group, 79.8% experienced “good” or “excellent” results with 12% complication rate and 2.8% reoperation rate. In the endoscopic group, 81.8% experienced “good” or “excellent” results with 9% complication rate and 1.6% reoperation rate. Meta-analysis of 3 comparative studies demonstrated a significantly lower overall complication rate with ECTuR. Subgroup analysis of complications revealed a significantly higher incidence of scar tenderness and elbow pain with OCTuR. Conclusions: The current study demonstrates similar effectiveness between the endoscopic (ECTuR) and open (OCTuR) techniques for treatment of idiopathic cubital tunnel syndrome with similar outcomes, complication profiles, and reoperation rates.
Patient-Reported Outcomes Following Surgically Managed Perilunate Dislocation
Authors: Griffin Michelle , Roushdi Ibrahim , Osagie Liza , Cerovac Sonja , Umarji Shamim
Published: May 2016

Background: Perilunate dislocations (PLDs) are uncommon high-energy injuries that may result in significant morbidity if inadequately treated. We report the midterm outcomes following surgical intervention and the validity of the Patient-Rated Wrist Evaluation (PRWE) score as an assessment tool post injury. Methods: We prospectively present outcomes in 16 patients with perilunate injuries. Definitive surgical management comprised fixation of all fractures and anatomical reconstruction of ruptured ligaments where possible. All patients completed the Disabilities of the Arm, Shoulder and Hand (DASH), 12-Item Short-Form Health Survey, and PRWE, for which internal consistency and construct validity were assessed. Results: At 24 months, the mean grip strength was 59% of the uninjured side (range 33%-85%) and the mean range of flexion was 71% and extension was 58%. Eighty-eight percent of patients returned to work within 6 months and 63% to sport within 1 year. The PRWE score was 36.2 (range 14.5-77.3) and DASH 25.2 (range 7.5-91.7). The mean visual analog scale (VAS) satisfaction score was 7.9 (range 0-10), VAS pain at rest 1.9 (range 0-6) and on activity 3.3 (range 1-6). DASH and PRWE demonstrated similar internal consistencies with Cronbach alphas of .98 and .91, respectively, and a strongly positive correlation coefficient of r = +.7 ( P < .05). Conclusions: Surgical treatment of PLDs can provide good clinical outcomes allowing patients to return to normal activities in a reasonable timescale when delays to surgery are kept to a minimum. The PRWE demonstrated high internal consistency and was found to be a valid questionnaire with advantages over the DASH for use following severe carpal injures.
Extensor Indicis Proprius Tenodesis to Correct Finger Ulnar Drift Deformity in Rheumatoid Arthritis
Authors: Monreal Ricardo
Published: May 2016

Background: The most frequent deformity of the hand occurring in patients with RA affects the metacarpophalangeal (MCP) joint and it is characterized by a volar subluxation of the proximal phalanges and ulnar drift of the fingers. Methods: The Extensor Indicis Proprius (EIP) tenodesis for correction of ulnar deviation of fingers (II to V) was performed in 10 hands (40 fingers and 5 patients). Results: There was complete correction of the subluxation or dislocation and almost complete correction of the ulnar drift of the metacarpophalangeal joints at the initial postoperative evaluation (three to four months after surgery). However, at final evaluation (eight to twelve months after the operation), all of the digits had some recurrence of ulnar deviation. Conclusion: The EIP tenodesis provides a correct forces vector to maintain the fingers in proper alignment following correction of ulnar deviation.
Assessment of Wrist Function After Simulated Total Wrist Arthrodesis
Authors: Hinds Richard M. , Melamed Eitan , O’Connell April , Cherry Francoise , Seu Monica , Capo John T.
Published: May 2016

Background: There is poor consensus in the literature regarding associated functional limitation and the preferred wrist position for total wrist arthrodesis. The purpose of the current investigation was twofold: (1) to assess the functional limitations of wrist arthrodesis and (2) to determine the optimal position for wrist arthrodesis using a simulated wrist fusion model. Methods: Twenty healthy volunteers underwent simulated wrist arthrodesis in 6 different positions using custom-molded wrist splints: 15° extension with 0° radio-ulnar deviation, 15° extension with 10° ulnar deviation, 15° extension with 10° radial deviation, 0° extension with 0° radio-ulnar deviation, 0° extension with 10° ulnar deviation, and 0° extension with 10° radial deviation. Each volunteer was independently assessed for wrist function using the Jebsen-Taylor hand function test, grip strength, and satisfaction in the simulated wrist fusion positions. Comparisons between all simulated fusion wrists and the baseline unsplinted wrist as well as among the 6 simulated fusion positions were performed. Results: Turning over a card (5.1 vs 4.3 seconds), picking up small objects (7.1 vs 5.8 seconds), and simulated feeding (8.3 vs 7.1 seconds) as well as total Jebsen-Taylor test duration (41.8 vs 37.9 seconds) was significantly longer in simulated fusion wrists. Both grip strength (55.9 vs 80.7 kg) and satisfaction scores (6.4 vs 9.6) were lower in simulated fusion wrists. Wrists in 0° extension also demonstrated significantly shorter durations in stacking checkers than wrists in 15° extension. Conclusion: Our findings suggest that wrist arthrodesis may only compromise select wrist functions. Among the tested wrist fusion positions, wrists fused in neutral may demonstrate better function than wrist fused in slight extension. However, grip strength and satisfaction seem to be unaffected by wrist fusion position.
Radiation Exposure and Hand Dominance Using Mini C-Arm Fluoroscopy in Hand Surgery
Authors: Fuller Corey B. , Wongworawat Montri D. , Riedel Barth B.
Published: May 2016

Background: The mini C-arm is popular with hand surgeons, and they are particularly at risk for radiation exposure, as they cannot easily distance themselves from the radiation beam. We hypothesized that the nondominant hand receives more radiation exposure than the dominant hand as it is generally closer to the radiation source. This study seeks to determine whether a hand surgeon receives a different amount of radiation exposure to their hands based on hand dominance and then accounting for this, provide a more accurate assessment of hand radiation exposure from mini C-arm fluoroscopy. Methods: Two fellowship-trained hand surgeons wore ring dosimeters on both hands during surgeries with mini C-arm fluoroscopy involving bony work of the forearm and hand. Radiation exposure to the hands was measured from ring dosimeters. Results: Six-ring dosimeter pairs were worn during 64 cases, averaging 10.7 cases per ring. No ring met the minimal dose threshold of 30 mrem to record a numerical value. Each ring experienced an average of 413 seconds of fluoroscopy time and 66.3509 cGy*cm2 of radiation output from the mini C-arm. Conclusions: The results do not allow comparison of radiation exposure related to hand dominance. Assuming worst-case scenario: each ring measured 29 mrem (just below the threshold), the surgeon’s hands experienced 2.7 mrem per case. This would allow a hand surgeon to perform 18 391 cases per year before exceeding the allowable annual hand exposure limit of 50 000 mrem set by the National Council of Radiation Protection and Measurements and International Commission on Radiological Protection.
A Multicenter, Prospective, Randomized, Pilot Study of Outcomes for Digital Nerve Repair in the Hand Using Hollow Conduit Compared With Processed Allograft Nerve
Authors: Means Kenneth R. , Rinker Brian D. , Higgins James P. , Payne S. Houston , Merrell Gregory A. , Wilgis E. F. Shaw
Published: May 2016

Background: Current repair options for peripheral nerve injuries where tension-free gap closure is not possible include allograft, processed nerve allograft, and hollow tube conduit. Here we report on the outcomes from a multicenter prospective, randomized, patient- and evaluator-blinded, pilot study comparing processed nerve allograft and hollow conduit for digital nerve reconstructions in the hand. Methods: Across 4 centers, consented participants meeting inclusion criteria while not meeting exclusion criteria were randomized intraoperatively to either processed nerve allograft or hollow conduit. Standard sensory and safety assessments were conducted at baseline, 1, 3, 6, 9, and 12 months after reconstruction. The primary outcome was static 2-point discrimination (s2PD) testing. Participants and assessors were blinded to treatment. The contralateral digit served as the control. Results: We randomized 23 participants with 31 digital nerve injuries. Sixteen participants with 20 repairs had at least 6 months of follow-up while 12-month follow-up was available for 15 repairs. There were no significant differences in participant and baseline characteristics between treatment groups. The predominant nerve injury was laceration/sharp transection. The mean ± SD length of the nerve gap prior to repair was 12 ± 4 mm (5-20 mm) for both groups. The average s2PD for processed allograft was 5 ± 1 mm (n = 6) compared with 8 ± 5 mm (n = 9) for hollow conduits. The average moving 2PD for processed allograft was 5 ± 1 mm compared with 7 ± 5 mm for hollow conduits. All injuries randomized to processed nerve allograft returned some degree of s2PD as compared with 75% of the repairs in the conduit group. Two hollow conduits and one allograft were lost due to infection during the study. Conclusions: In this pilot study, patients whose digital nerve reconstructions were performed with processed nerve allografts had significantly improved and more consistent functional sensory outcomes compared with hollow conduits.
Parsonage-Turner Syndrome
Authors: Milner Chris S. , Kannan Kumar , Iyer Vasudeva G. , Thirkannad Sunil M.
Published: May 2016

Background: Parsonage-Turner Syndrome (PTS) is a rare but serious condition characterized by spontaneous paresis of the upper extremity, typically lasting several months with variable recovery. With little literature on the behavior of PTS from a hand surgeon’s perspective, accurate diagnosis and subsequent counseling of patients with PTS can be challenging. Methods: This study is a retrospective evaluation of the clinical features of all PTS patients seen over a 9-year period. Data was collected for gender, side affected, handedness, inciting event, clinical presentation, nerve involvement, time taken for recovery, and extent of recovery. Results: Thirty-eight adult cases of PTS were identified, representing an incidence of 0.34 per 1000. Fifty-five percent were female, with predomination of right handedness and dominant upper extremity involvement (60% and 58%, respectively). There was an inciting incident identified in 42% of cases, and 37% of these involved surgery. Twenty-nine percent of cases presented without experiencing typical neuropathic pain. There was a predomination of anterior interosseous nerve (AIN) or posterior interosseous nerve (PIN) involvement (42% overall). Only 44% of patients achieved a complete recovery, taking a mean duration of 10 months. Conclusions: This study highlights both the rarity and atypical spectrum of clinical presentation of PTS, especially considering the more common involvement found for AIN and PIN. This highlights the likelihood that patients presenting with PTS to a hand surgical practice may differ from those typically described in the literature. The poor rate of recovery is in line with other recent reports and contrasts with the more positive outcomes found in earlier studies.
Distal Inside-Out Epineural Sliding Technique to Repair Segmental Nerve Defects
Authors: Luokkala Toni , Ryhänen Jorma , Näpänkangas Juha , Karjalainen Teemu V
Published: May 2016

Background: The repair of a segmental peripheral nerve injury is a clinical challenge. Several studies have been performed to determine superior methods for overcoming nerve gaps. The purpose of this study was to investigate if the inside-out slided epineurium of the distal segment of an injured nerve can serve as a conduit to bridge a short nerve defect (10 mm). Methods: Nineteen sciatic nerves in Sprague–Dawley rats were transected, and a 10-mm gap was left between the ends. A section of distal epineurium was pulled inside out to bridge the gap. Walking track analysis was performed, and the sciatic function index (SFI) was calculated. Wet muscle mass and withdrawal reflex were measured. The density of axon fibers at different levels of repaired nerves was determined, and histological analysis was performed at 16 weeks. Results: The mean SFI improved from −81.0 at 4 weeks to 36.3 at 16 weeks. The axon densities showed regeneration through the epineural tube, and 5 of the rats demonstrated a withdrawal reflex. The weight of the tibialis anterior muscle of the injured limb at 16 weeks was 59% that of the uninjured side. Conclusions: The distal epineural sheath tube provided a size-matched conduit between the nerve stumps, with no histological donor-site morbidity. Histologically, regeneration occurred through the epineural tube without neuroma formation, and functional recovery was comparable to that of previous studies of nerve repair techniques. Technique may be an addition to the armamentarium of tools used to treat segmental nerve defects.
Interfascicular Renal Cell Carcinoma Metastasis to the Ulnar Nerve
Authors: Humphries Laura S. , Baluch Daniel A. , Nystrom Lukas M. , Borys Dariusz , Bednar Michael S.
Published: May 2016

Background: Metastatic solid tumors to the hand and peripheral nerves are exceedingly rare independent occurrences. Their occurrence together has never been reported in the literature. Methods: We present a case report of a 69 year old male with a previous history of renal cell carcinoma (RCC) presenting with a rapidly-growing painful mass located at the right volar ulnar wrist, found to have endoneural solid tumor metastatic RCC to the ulnar nerve. Results: Preoperative MRI imaging of the wrist revealed a heterogeneous mass on the volar aspect of the wrist extending along the length of the ulnar artery and nerve to the level of Guyon’s canal. Pathologic examination of an incisional biopsy of the mass was consistent with metastatic renal clear cell carcinoma cells, which were infiltrating nerve and surrounding soft tissue. The patient underwent local radiation therapy to the wrist and hand with interval decrease in size of the mass and symptom improvement. Conclusion: Solid tumor metastasis, although exceedingly rare, must be considered in the differential diagnosis of a patient with previous cancer history presenting with a wrist or hand mass associated with peripheral neuropathy.
Foreign-Body Reaction and Osteolysis in Dorsal Lunate Dislocation Repair With Bioabsorbable Suture Anchor
Authors: Zaidenberg Ezequiel Ernesto , Roitman Pablo , Gallucci Gerardo Luis , Boretto Jorge Guillermo , De Carli Pablo
Published: May 2016

Background: In recent years the use of biodegradable suture anchors for treating tendon and ligament pathology in hand surgery became popular. These materials are biocompatible, radiolucent, and load sharing, as they incrementally transfer load to surrounding bone during the resorption process. Despite these numerous advantages, polyglycolic (PGA) and poly-L-lactic acid (PLLA) have become a problem because of the potential risk for foreign body reactions. Methods: This article presents a case of an intraosseous foreign body reaction and massive osteolysis of the proximal carpal after dorsal lunate dislocation repair with bioabsorbable suture anchors. Results: Because of the persistent pain and the decreased strength, a proximal row carpectomy was performed 12-months after the initial trauma. Conclusions: Hand surgeons should be aware of the possibility of a late foreign body reaction, that could be especially severe in carpal bones.
Pediatric Trigger Finger due to Osteochondroma
Authors: de Oliveira Ricardo Kaempf , Delgado Pedro J. , Geist João Guilherme Brochado
Published: May 2016

Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.
Compensation by the Uninjured Arm After Brachial Plexus Injury
Authors: Mancuso Carol A. , Lee Steve K. , Dy Christopher J. , Landers Zoe A. , Model Zina , Wolfe Scott W.
Published: May 2016

Background: The goals of this study were to assess how preoperative and postoperative patients use their uninjured arm to compensate for adult brachial plexus injury (BPI) and to determine whether the Disabilities of Arm, Shoulder, and Hand (DASH) Questionnaire measures this compensation. Methods: Ten preoperative and 13 postoperative patients were enrolled in this qualitative-quantitative study. During the qualitative phase, patients were asked how they compensated because of BPI; responses were analyzed with grounded theory. During the quantitative phase, patients completed a standard-DASH reflecting the ability to do activities in any way using both arms as necessary, and a qualified-DASH reflecting their estimated ability to do activities using the uninjured arm the way they otherwise usually would. Two DASH scores were calculated (range, 0-100, higher = worse) and were compared with paired t tests. Results: There were 3 categories of compensation: using the uninjured arm more, exclusively, or to position the injured arm so that the hand (if functional) could be used. The mean standard-DASH and qualified-DASH scores, respectively, were 52 and 74 for preoperative patients (difference 22, P < .0001), and 41 and 64 for postoperative patients (difference 23, P = .0008). Conclusions: Patients with BPI report different types of compensation by the uninjured arm which can be discerned by the DASH.
Update of the Quick DASH Questionnaire to Account for Modern Technology
Authors: Moradi Ali , Menendez Mariano E. , Kachooei Amir Reza , Isakov Aleksandr , Ring David
Published: May 2016

Background: Almost 2 decades have passed since the development of the items contained in the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and during this time, daily tasks have changed to adapt to changes in technology. Methods: A cohort of 108 patients completed demographic information, the Quick DASH (both standard and technologically updated versions), and 2 Patient-Reported Outcomes Measurement Information System (PROMIS)-based computerized adaptive testing questionnaires: PROMIS pain interference and upper-extremity function. To create a technologically updated Quick DASH, we substituted 3 items from the standard Quick DASH questionnaire with 3 other items related to the use of technology: (1) Text or dial with your cell phone, (2) Type on a keyboard, and (3) Use a computer mouse. Results: The technologically updated Quick DASH questionnaire had lower scores compared with the standard Quick DASH (37 vs. 33, respectively), but they had a large correlation and both had high internal consistency. The items “Text or dial with your cell phone” and “Use a computer mouse” in the updated Quick DASH questionnaire had the lowest scores. Except for affected side, the standard Quick DASH and updated Quick DASH were influenced by the same factors. PROMIS pain interference was the only independent variable affecting both questionnaire scores. Conclusions: A technologically updated Quick DASH had no advantage over the standard Quick DASH.
Triggering of Carpal Tunnel Syndrome Symptoms in Patients Using Urban Public Transportation
Authors: de Saboya Lenzi Luiz Guilherme , Fernandes Carlos Henrique , Myiamoto Meirelles Lia , Baptista Gomes dos Santos João , Faloppa Flávio , Raduan Neto Jorge
Published: May 2016

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy found in clinical practice. Recent studies evaluated which external factors could be involved in the CTS symptoms, including prolonged exposure to vibration, especially in the upper limb. This study investigated signs and symptoms in patients with CTS after using urban transport on (1) both upper limbs, (2) how long before these symptoms appear, and (3) the hands position or body reaction during the act of pressing the safety bars. Methods: The study was conducted from July 2012 to April 2013. A total of 205 (178 women and 27 men) patients were evaluated. CTS was diagnosed in 285 hands. All participants answered a questionnaire formulated by the authors. The questionnaire was applied by researchers who were single-blinded and not involved in the research. Results: Most of the participants (87%) were women, but there was no statistical significance in age between groups (women = 51.24 ± 8.47 years, men = 51.10 ± 6.52 years, P > .05). The symptoms appeared significantly in the first 15 minutes after boarding when compared with patients who had no symptoms during the journey. There was no difference between hands position along the journey and the onset of symptoms. Conclusions: The onset of symptoms in patients with CTS using urban public transportation most commonly occurred in the first 15 minutes after boarding. Public transport vibration seems to be, at least in part, directly related to the development of symptoms. Questionnaires for the assessment of paresthesia symptoms during the use of public transport may be useful for CTS diagnosis.
Hand Surgery and Fluoroscopic Eye Radiation Dosage
Authors: Wang Mark L. , Hoffler C. Edward , Ilyas Asif M. , Kirkpatrick William H. , Beredjiklian Pedro K. , Leinberry Charles F.
Published: May 2016

Background: The purpose of this study is to (1) perform a prospective pilot comparison of the impact of large versus mini C-arm fluoroscopy on resultant eye radiation exposure and (2) test the hypothesis that the use of either modality during routine hand surgery does not exceed the current recommended limits to critical eye radiation dosage. Methods: Over a 12-month period, eye radiation exposure was prospectively measured by a board-certified hand surgeon using both large and mini C-arm fluoroscopy. For each modality, accumulated eye radiation dosage was measured monthly, while fluoroscopic radiation output was recorded, including total exposure time and dose rate. Results: A total of 58 cases were recorded using large C-arm and 25 cases using mini C-arm. Between the 2 groups, there was not a significant difference with total exposure time ( P = .88) and average dose rate per case ( P = .10). With the use of either modality, average monthly eye radiation exposure fell within the undetectable range (<30 mrem), significantly less than the current recommended limit of critical eye radiation (167 mrem/month). Conclusions: The impact of various fluoroscopic sources on eye radiation exposure remains relatively unexplored. In this study, the minimal detectable eye radiation dosages observed in both groups were reliably consistent. Our findings suggest that accumulated eye radiation dosage, from the use of either fluoroscopic modality, does not approach previously reported levels of critical radiation loads.
Patient Comprehension of Carpal Tunnel Surgery
Authors: Waryasz Gregory R. , Gil Joseph A. , Chiou Daniel , Ramos Paul , Schiller Jonathan R. , DaSilva Manuel F.
Published: May 2016

Background: Health literacy is the ability of a patient to understand their medical condition. The purpose of this investigation is to determine whether patients are able to obtain an elementary understanding of the fundamental principles of carpal tunnel release and the postoperative instructions after going through the process of informed consent and being provided an additional standardized postoperative instruction document. Our hypothesis is that patients will lack an understanding of these principles and, therefore, will be at risk for being noncompliant in their postoperative care. Methods: Fifty patients with a diagnosis of carpal tunnel surgery who elected to undergo carpal tunnel release alone were enrolled. A standardized education process was performed. Patients completed the questionnaire at their postoperative visit. Results: The average percentage of correct answers was 75.8% (8.34 out of 11 correct). Fisher exact test analysis demonstrated that patients with a lower education level were less likely to know how long it takes for their preoperative symptoms to resolve ( P = .0071), and they were less likely to correctly choose all of the important elements of postoperative care during the first week after surgery ( P = .022). Conclusions: Although we made efforts to help patients achieve health literacy in carpal tunnel surgery, we found that patients continued to lack comprehension of pertinent components of carpal tunnel surgery, particularly understanding the involved anatomy.
Complications and Outcomes of One-Bone Forearm Reconstruction
Authors: Kim So Yeon , Chim Harvey , Bishop Allen T. , Shin Alexander Y.
Published: May 2016

Background: The objective of this study was to review the outcomes of patients who underwent one-bone forearm (OBF) reconstruction. Methods: A retrospective review of patients who underwent OBF surgery between 1994 and 2014 was undertaken. Patient demographics, etiology, associated injuries, number of surgeries prior to OBF surgery, surgical details, and postoperative information were collected. A telephone interview was conducted at final follow-up, including a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, a 10-point scoring system used by Peterson et al, and a series of questions concerning pain and patient satisfaction. Results: There were 6 males and 2 females with a mean age of 44 years (range, 20-66 years). All patients had traumatic etiology, with 6 having open wounds and 2 having closed wounds. All patients had union with a mean follow-up of 83.6 months (range, 16-218 months). The mean pain score was 3 (range, 0-8), of which 3 were painless (score 0). The mean QuickDASH score was 39 (range, 7-75), and 4 patients had good or excellent results according to the 10-point score system used by Peterson et al. All patients were satisfied with the result. Five of 8 had complications related to soft tissues that were residual from their prior injuries and surgeries. One patient had post healing fracture requiring revision fixation and 1 had a postoperative infection requiring parenteral antibiotics. Conclusions: OBF surgery is an effective salvage procedure for complicated forearm instability, particularly after trauma. While union rates are high, complications are typically related to pain and soft tissue secondary to the previous injury and reconstructive procedures.
A Preliminary Assessment of the Utility of Large-Caliber Processed Nerve Allografts for the Repair of Upper Extremity Nerve Injuries
Authors: Isaacs Jonathan , Safa Bauback
Published: May 2016

Background: Cabled sensory nerve autografts are the historical gold standard for overcoming gaps in larger diameter nerves as repair utilizing large-diameter autograft risks central graft necrosis. Commercially available processed nerve allograft (PNA) is available in diameters up to 5 mm but represents an acellular 3-dimensional matrix as opposed to viable tissue. The purpose of this study is to specifically evaluate whether similar concerns regarding the use of large-caliber PNA are warranted. Methods: The RANGER Registry is an active database designed to collect injury, repair, safety, and outcomes data for PNAs (Avance® Nerve Graft; AxoGen, Inc, Alachua, Florida) according to an institutional review board–approved protocol. The database was queried for patients presenting with large-caliber nerve allograft repairs in the upper extremity. Identified patients reporting quantitative outcomes with a minimum of 9-month follow-up were included in the data set. Results: The large-caliber PNA subgroup included 13 patients with 15 injuries. The mean ± SD age was 36 ± 22 years. Large-caliber single-stranded repairs included twelve 4- to 5-mm-diameter grafts. Large-caliber cabled repairs included the combined use of 3- to 4-mm and 4- to 5-mm-diameter nerve allografts in 3 repairs. The mean nerve gap was 33 ± 10 mm with a mean follow-up time of 13 months. Available quantitative data reported meaningful recovery of sensory and motor function in 67% and 85% of the repairs, respectively. Conclusion: Although based on a small subset of patients, PNAs of up to 5 mm in diameter appear capable of supporting successful nerve regeneration.
Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014
Authors: Lipman Marc D. , Carstensen Samuel Evan , Deal Dylan Nicole
Published: May 2016

Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased ( P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.
Theoretical and experimental studies on dynamics of double-helical gear system supported by journal bearings
Authors: Yin Minghu , Chen Guoding , Su Hua
Published: May 2016

The dynamic behaviour of a double-helical gear system supported by journal bearings is theoretically and experimentally investigated in this study. A bending–torsional–axial coupling model for dynamic analysis of double-helical gear system is developed. Influence of the time-varying mesh stiffness and damping is considered. Oil film stiffness and damping of the supporting journal bearing are supposed to be time-varying, and the time-varying oil film stiffness and damping are predicted by a back propagation neural network, which is optimized by genetic algorithm. A double-helical gear–rotor–journal bearing system test rig is also established to carry out the experimental investigations, such as the dynamic transmission errors of gear pairs. The comparisons between theoretical and experimental results show that the time-varying oil film dynamic coefficients of journal bearings are an important internal excitation. The theoretical model with time-varying oil film stiffness and damping can predict the gear dynamics more accurate than the model with time-invariant oil film stiffness and damping, and the neural network optimized by genetic algorithm can obtain the time-varying oil film stiffness and damping efficiently and accurately for the dynamic analysis of double-helical gear system.
Optimal design of hydraulic excavator working device based on multiple surrogate models
Authors: Qiu Qingying , Li Bing , Feng Peien
Published: May 2016

The optimal design of hydraulic excavator working device is often characterized by computationally expensive analysis methods such as finite element analysis. Significant difficulties also exist when using a sensitivity-based decomposition approach to such practical engineering problems because explicit mathematical formulas between the objective function and design variables are impossible to formulate. An effective alternative is known as the surrogate model. The purpose of this article is to provide a comparative study on multiple surrogate models, including the response surface methodology, Kriging, radial basis function, and support vector machine, and select the one that best fits the optimization of the working device. In this article, a new modeling strategy based on the combination of the dimension variables between hinge joints and the forces loaded on hinge joints of the working device is proposed. In addition, the extent to which the accuracy of the surrogate models depends on different design variables is presented. The bionic intelligent optimization algorithm is then used to obtain the optimal results, which demonstrate that the maximum stresses calculated by the predicted method and finite element analysis are quite similar, but the efficiency of the former is much higher than that of the latter.
Preventive maintenance for a single-machine system under variable operational conditions
Authors: Hu Jiawen , Jiang Zuhua , Wang Hong
Published: May 2016

It is a common industrial practice that machines work under variable operational conditions. This article develops an imperfect maintenance model for machines working under variable operational condition, assuming that the failure time distribution of machines under different operational conditions follows the accelerated failure time model. To deal with the case that the future operational conditions’ information over the planning time interval are unknown in advance, it proposes a preventive maintenance policy which is based on current hazard rate function. An example is studied, and the results are compared with the cases that the whole operational condition information is given in advance, and the influence of operational condition is not considered. The results reveal the necessity of integrating operational condition with preventive maintenance optimization. In addition, the performance of the proposed policy has been explored with different parameters of operational conditions.
Decolonizing the ‘Global’: The Coloniality of Method and the Problem of the Unit of Analysis
Authors: Ascione Gennaro
Published: May 2016

What should ‘global’ stand for in order to qualify ‘historical sociology’ when it aspires to move beyond its Eurocentric foundations? The answer to this question lies in the ability to investigate the limits that Eurocentrism imposes on the possibility of reformulating the world as a unit of analysis, and simultaneously in tackling the centrality of the colonial question in methodological and epistemological terms, rather than exclusively in historical terms.
Clinical impact of dual red imaging in colorectal endoscopic submucosal dissection: a pilot study
Authors: Ninomiya Yuki , Oka Shiro , Tanaka Shinji , Hirano Daiki , Sumimoto Kyoku , Tamaru Yuzuru , Asayama Naoki , Shigita Kenjiro , Nishiyama Soki , Hayashi Nana , Chayama Kazuaki
Published: May 2016

Background:

Dual red imaging (DRI), a novel image-enhanced endoscopic technique, is expected to improve visibility of thin vessels, but no reports of the clinical use of DRI in colorectal endoscopic submucosal dissection (ESD) have been published. We aimed to compare the visibility of vessels, demarcation line between the submucosal and muscle layers after injection of hyaluronate sodium with minute indigo carmine, and fibrosis on DRI with that on white light imaging (WLI). We applied the principle of DRI to the image of the submucosal layer during colorectal ESD as a pilot study.

Methods:

A total of seven physicians compared 17 DRI images to the corresponding WLI images in colorectal ESD. The physicians compared the number of arteries identified on DRI with the actual number of arteries. The physicians rated the visibility of vessels, the demarcation line between the submucosal and muscle layers after injection of hyaluronate sodium with minute indigo carmine, and fibrosis. Inter-observer agreement was also examined using the kappa statistic.

Results:

Visibility of vessels and the demarcation line between the submucosal and muscle layers after injection of hyaluronate sodium with minute indigo carmine improved with the use of DRI compared with that using WLI. DRI can discriminate between arteries and veins clearly through the color of the vessels.

Conclusions:

DRI improves the visibility of vessels, especially that of arteries, as they appear orange, and the demarcation line of the muscle layer. DRI may help to make colorectal ESD safer and faster.
Post-biliary sphincterotomy bleeding despite covered metallic stent deployment
Authors: Donatelli Gianfranco , Cereatti Fabrizio , Dumont Jean-Loup , Dhumane Parag , Tuszynski Thierry , Vergeau Bertrand Marie , Meduri Bruno
Published: May 2016

Objectives:

Several endoscopic techniques have been proposed for the management of post-sphincterotomy bleeding. Lately, self-expandable metal stents deployment has gained popularity especially as a rescue therapy when other endoscopic techniques fail.

Methods-results:

We report the case report of a massive post-sphincterotomy bleeding in a patient with a self-expandable metal stent in the biliary tree. Despite the presence of a correctly positioned self-expandable metal stent, a new endoscopic session was required to control the bleeding.

Conclusions:

Self-expandable metal stent may be useful to manage post-endoscopic sphincterotomy bleeding. However, up to now there is no specifically designed self-expandable metal stent for such complication. Large new designed self-expandable metal stent may be a useful tool for biliary endoscopist.
Seroprevalence of feline immunodeficiency virus and feline leukaemia virus in Australia: risk factors for infection and geographical influences (2011–2013)
Authors: Westman Mark E , Paul Amanda , Malik Richard , McDonagh Phillip , Ward Michael P , Hall Evelyn , Norris Jacqueline M
Published: May 2016

Objectives

Our aim was to: (i) determine the current seroprevalence of feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) in three large cohorts of cats from Australia; and (ii) investigate potential risk factors for retroviral infection.

Methods

Cohort 1 (n = 2151 for FIV, n = 2241 for FeLV) consisted of cats surrendered to a shelter on the west coast of Australia (Perth, Western Australia [WA]). Cohort 2 (n = 2083 for FIV, n = 2032 for FeLV) consisted of client-owned cats with outdoor access recruited from around Australia through participating veterinary clinics. Cohort 3 (n = 169 for FIV, n = 166 for FeLV) consisted of cats presenting to Murdoch University Veterinary Hospital for a variety of reasons. Fresh whole blood was collected and tested using a commercially available point-of-care lateral flow ELISA kit that detects p27 FeLV antigen and antibodies to FIV antigens (p15 and p24) (cohorts 1 and 2), or one of two lateral flow immunochromatography kits that detect p27 antigen and antibodies to FIV antigen (p24 and/or gp40) (cohort 3). Data recorded for cats in cohort 2 included signalment, presenting complaint and postcode, allowing investigation of risk factors for FIV or FeLV infection, as well as potential geographical ‘hot spots’ for infection.

Results

The seroprevalence of FIV was 6% (cohort 1), 15% (cohort 2) and 14% (cohort 3), while the seroprevalence of FeLV was 1%, 2% and 4% in the same respective cohorts. Risk factors for FIV infection among cats in cohort 2 included age (>3 years), sex (male), neutering status (entire males) and location (WA had a significantly higher FIV seroprevalence compared with the Australian Capital Territory, New South Wales and Victoria). Risk factors for FeLV infection among cats in cohort 2 included health status (‘sick’) and location (WA cats were approximately three times more likely to be FeLV-infected compared with the rest of Australia). No geographical hot spots of FIV infection were identified.

Conclusions and relevance

Both FIV and FeLV remain important infections among Australian cats. WA has a higher seroprevalence of both feline retroviruses compared with the rest of Australia, which has been noted in previous studies. A lower neutering rate for client-owned male cats is likely responsible for the higher seroprevalence of FIV infection in WA cats, while the reason for the higher seroprevalence of FeLV in WA cats is currently unknown.