bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Intra-articular PIP Fractures Do Better With Swing Traction or No-Traction Protocols? A Cohort Study
Authors: O’Brien Lisa , Simm Andrew T. , Loh Ian W. H. , Griffiths Kim M.
Published: September 2016

Objective/Hypothesis: The objective of this study was to compare swing traction versus no-traction management of complex fractures of proximal interphalangeal (PIP) finger joints. We hypothesized that there is no long-term (ie, >12 month) difference between swing traction and no traction (with or without surgical fixation) in terms of motion, pain, function, patient satisfaction, or treatment cost. Materials and Methods: This cohort study recruited adults with a history of complex PIP fractures affecting ≥ 30% of articular surface injury identified from database searches at 3 public hospitals and a private clinic. The x-rays taken at the time of injury were graded by 2 blinded assessors, and participants attended a clinic for measurement of range of motion (ROM) and self-reported function, pain, and satisfaction. Participant data were then grouped by treatment provided. One group (n = 17) was treated with swing traction and the other group (n = 14) had no traction. The primary outcome was combined motion of the PIP and distal interphalangeal (DIP) joints, expressed as both total active motion and Strickland score. Secondary outcomes were physical function and symptoms as measured by the Disabilities of Arm, Shoulder and Hand (DASH), patient satisfaction, pain, complication rates, and cost of treatment, based on mean resource consumption per group. Results: Patients treated with swing traction had greater finger motion than those in the no-traction group, which was statistically and clinically significant. There were no differences in patient ratings of function, pain, or satisfaction. Complications, such as swan-neck deformity, cold sensitivity, malunion, infection, or adhesions occurred in over half of both groups of participants. During the treatment phase, the swing traction group attended hand therapy an average of 13.3 times and the no-traction group attended 11.7 times. Average costs for swing traction were less than that for surgical fixation with no traction. Conclusions: Patients treated with the swing traction protocol had greater ROM in the finger; however, this did not translate to improved patient ratings of function, pain, or satisfaction. A basic cost comparison indicated that swing traction may be less expensive than other forms of surgical repair.
Carpal Instability After a Fall Onto Outstretched Hand
Authors: O’Brien Lisa , Robinson Luke , O’Sullivan Hayley , Lim Eugene
Published: September 2016

Objective/Hypothesis: Carpal dislocations are easily missed on initial presentation, as x-rays can appear unremarkable. It is thought that perilunate injuries in general make up around 10% to 19% of all wrist sprains; however, no incidence or prevalence studies have been undertaken. We aimed to establish the incidence of carpal instability between 1 and 2 years post acute wrist injury as the result of a fall using established clinical and radiological measures and secondarily, attempt to estimate its relationship with functional impairment. Materials and Methods: This incidence study used multiple overlapping sources to ascertain all patients presenting to a major urban hospital with wrist pain following fall onto outstretched hand between 1and 2 years post injury. Carpal instability was defined by blinded radiological evaluations and provocative clinical tests, including Scaphoid Shift (Watson) test, ballottement, and midcarpal shift test. Wrist-related pain and disability were measured using the patient-rated wrist and hand evaluation. Results: Fifty participants (28 male, 22 female) with a mean age of 47.8 years met inclusion criteria. We found a cumulative incidence of 40% of carpal instability within the second year post injury, based on clinical testing. X-ray evaluations were inconsistent with clinical findings. There were no significant correlations between clinically confirmed carpal instability and presence of fracture at the time of injury, pain, function, age, sex, high energy trauma, or sick days from work. Conclusions: This study found a higher than anticipated cumulative incidence of carpal instability in the second year post injury. Patients should be advised to monitor symptoms in the year post injury and seek a review if symptoms of pain, clicking, or clunking arise.
Using Vibratory Stimulations in Stiffness of PIP Joint
Authors: Bailly Nicolas
Published: September 2016

Introduction: The management of posttraumatic stiffness of the proximal interphalangeal (PIP) joints is common in hand therapy. Many processing devices have a localized effect but slightly stimulate motor imagery and cortical pattern. The goal of our study was to evaluate the functional results of vibratory stimulation transcutaneous in treatment of the stiffness of PIP joints. Materials and Methods: This is a prospective and randomized study, within the Hand & Wrist Unit in Meyrin/Geneva during June 2014 and February 2015. The patients were included and randomized in 2 groups: V (with vibrations) and T (control, without vibration). We included monoarticular stiffness PIP and painful visual analogue scale (VAS) > 3. We excluded bone lesions, surgery, median strip extension injury, and cognitive disorders. The rehabilitation protocol was the same in the too groups except an additional time of 10 minutes of vibration for the group V. The evaluation criteria included pain by VAS and range of motion measured with a goniometer. This evaluation was carried out during the first session day 0 to day 21 and day 45. Statistical analysis was performed by the Student test for quantitative variables. The significance level P < .05 was considered significant. Results: Twenty-one patients were included in the study, including 11 in the average V age group of 38.5 years (25-59), and 10 in the T group with mean age of 43.1 years (24-58). During the first 3 weeks of treatment, there was a greater decrease in pain for the V group and the T group, respectively with a median reduction of pain (VAS) of −2.25 and −1.5 ( P = .01). The flexion gain was better in the V group than the T group, with a rate of median recovery in flexion 57% and 43%, respectively, ( P = .03). The 2 groups were comparable for the recovery of the extension. During the last 3 weeks of the treatment, no significant difference in the range of motion (flexion and extension) was found between the 2 groups. Conclusion: The use of vibratory stimulation transcutaneous achieves better results in terms of pain and bending amplitude gain in stiffness of PIP joint during the first 3 weeks of rehabilitation. However, it has not proved its superiority over conventional treatment in stiffness in extension of PIP joint. The anatomical architecture of the tendon (flat or cylindrical) would play a role in the effectiveness of treatment. The use of vibrations seems to be more effective on the tendons near bones prominences.
A Survey Study on the Use of Patient-Rated Outcome Measures Among Hand Occupational Therapists in Singapore
Authors: Tong D. L. , Yi J. Z. E.
Published: September 2016

Objective: The use of patient-rated outcome (PRO) measures in clinical practice can provide pertinent information regarding the limitations and restrictions in activities of daily living after an injury to the upper extremity from the patient’s perspective. The subjective information obtained is often vital to guide more client centered and hence effective therapy approach. This study specifically explored the current practice trends and the perception on the use of PRO measures among hand therapists in Singapore. This study aimed to identify the barriers that limit routine use of PRO measures locally. Materials and Methods: An online survey consisted of 10 questions was administered via SurveyMonkey. The link to the survey was distributed through e-mail to all hand therapists in the 7 acute general hospitals in Singapore on February 1, 2016. Occupational therapists who have more than 6 months of clinical experience in hand therapy were recruited. The survey was closed on February 29, 2016. Results: Information from 27 responses was analyzed in descriptive manner; 33.33% (n = 9) indicated that they use PRO measures with less than 25% of their patients and 2 therapists indicated they did not use PRO measures at all. Disabilities of the Arm, Shoulder and Hand (DASH)/quickDASH and Patient-Rated Wrist/Hand Evaluation (PRWHE) were more commonly used. The barriers to routine use of PRO measures were identified: (1) PRO measures taking too much time to administer, (2) patients having difficulty completing PRO measures, and (3) use of objective standardized assessment is more applicable in the setting. About 81.5% (n = 22) indicated that it is important for occupational therapists in hand therapy setting to use PRO measures and it should be used more often; 68% (n=19) agreed that there should be a PRO measure that is specifically designed for use in Singapore. “Fast to administer” was rated as the most important feature in PRO measures for the therapists to incorporate its use routinely. Conclusion: This study suggested that while hand occupational therapists in Singapore agree that it is vital to use PRO measures with their patients, they face various limitations in routine administration. It was found that Singapore therapists would prefer a PRO measure that is more culturally relevant and one that is fast to administer. Further research into seeking solutions to improve utilization rate of PRO measures in Singapore is required.
Upper Extremity Disability Is Associated With Grip Strength and Psychological Stress in Carpal Tunnel Syndrome According to a Patient-reported Questionnaire
Authors: Yoshida Akihito , Kurimoto Shigeru , Nishikawa Kikuko , Iwatsuki Katsuyuki , Hirata Hitoshi
Published: September 2016

Objective: We investigated which clinical factors influenced upper extremity disability in carpal tunnel syndrome (CTS). Materials and Methods: We analyzed 45 hands with CTS of patients enrolled in a prospective cohort study conducted from December 2012 to January 2015. The age among the participant group of 40 females and 5 males ranged from 30 to 86 (mean, 60.3 years). Forty-three patients were right-handed. Twenty-seven had bilateral CTS (36 hands). Operations were performed on 25 right and 20 left hands. Thirty-nine hands were classified as “Extreme CTS” (absence of median motor and sensory responses) according to the severity scale proposed by Padua. Hand10 was used as a validated upper-extremity disability assessment tool. Clinical assessments were comprised of patients’ characteristic, physical and psychological parameters. Patients’ characteristic consisted of age, body mass index, and duration of symptom. Physical parameters included grip strength, key pinch strength, pulp pinch strength, Semmes Weinstein Monofilament Test, static 2 point discrimination test (s2PD test), numerical rating scale for numbness, visual analogue scale for pain (pain VAS), and Japanese version of Short-Form McGill Pain Questionnaire (SF-MPQ). Psychological parameters included Japanese version of Self-rating Depression Scale, Japanese version of Pain Anxiety Symptom Scale–20 (PASS-20), and Stress Response Scale–18 (SRS-18). These assessments were conducted on the day before operation. Statistical Analysis: Factors that were significantly associated with Hand10 scores in bivariate analysis (Pearson correlation test or Spearman rank correlation test as appropriate) were entered into a multivariable analysis. A multiple regression analysis was used to identify factors that were independently associated with Hand10 scores. Results: Hand10 scores showed no statistical differences in terms of unilateral/bilateral CTS and sex differences. Single regression analysis showed that Hand10 scores correlated significantly with the pain VAS, SF-MPQ, PASS-20, SRS-18, s2PD at index and middle scores, and grip strength. Multiple regression analysis showed that grip strength ( B = 1.47, β = 0.49, P = .00) and SRS-18 score ( B = −0.91, β = −0.36, P = .02) were significant correlation factors for the Hand10 score ( R2 = 0.49). Conclusions: In patients with CTS, grip strength and psychological stress are significant correlating factors of disability according to a patient-administered upper extremity assessment.
Presentation of an Exerciser Applicable in the Scapholunate Instability Rehabilitation
Authors: Aguado Ledda Edin , Contin Maria Elina Canosa , Issaly Estefania , Lasser Daniela Soledad
Published: September 2016

Introduction: The predynamic (partial) and dynamic (total) injury of the scapholunate ligamentous complex conditions the normal kinetics and kinematics of the carpal bone in the performance of everyday activities. Considering this, we have designed an exerciser that allows the active flex extension of the wrist to work in a specific progressive and global way in the sagittal plane within the permanent adaptation sector I (up to 20°) and the usual movement sector II (up to 40°) of N. Kuhlmann. Materials and Methods: The instrument has been designed in rigid plastic with the support and subjection of the forearm and mobile distal handle, which moves within a mechanical blocked guide that allows the movement of the wrist flex extension in N. Kuhlmann I and II sectors. It is also possible to apply resistance in the movement according to the rehabilitation criteria. Outcome: The design of an exerciser that allows the active flex extension of the wrist has been accomplished for the treatment of the scapholunate ligamentous complex injury. Conclusions: The application of the exposed exerciser for the rehabilitation of the scapholunate instability restricts the joint excursion to a protected rank, avoiding the exposure to ligamentous or muscular tensions that may aggravate the pathology.
Compression of the Median Nerve in the Proximal Forearm
Authors: Jiménez Isidro , Delgado Pedro J. , Figueredo Federico A. , de Rozas Mario Gil , Martínez Sergio , Truan Juan R.
Published: September 2016

Background: The anterior interosseous nerve (AIN) is a motor nerve innervating the deep muscles of the forearm. Its compression is rare, its diagnosis is not easy, and the existence of 2 really differentiated injuries (anterior interosseous syndrome and Pronator Teres syndrome) seems to be, at least, questionable from a clinical point of view. Purpose: The purpose of this study was to study the results obtained after surgical treatment of patients clinically diagnosed of AIN compression by the Scratch Collapse Test (SCT). Materials and Methods: From June 2013 to January 2016, 20 patients underwent surgery for proximal compression of the median nerve. The diagnosis was made based on the patient’s symptoms and positivity of the SCT in three consecutive consultations. In all patients, electromyogram (EMG) and magnetic resonance imaging (MRI) were performed to exclude other space-occupying injuries that could justify the symptoms. They were 13 men and 7 women. Average age at surgery was 32 (13-53) years and follow-up was 14 (1-32) months. All surgeries were carried out by the same surgeon and all areas of possible nerve compression were released. In 4 cases, the diagnosis of “double crush syndrome” was made and the carpal tunnel was also released. Results: EMG was reported as abnormal only in patients diagnosed of “double crush syndrome.” MRI showed any abnormality in 4 patients. In all patients, the SCT was negative at the first postoperative consultation. All patients returned to their normal activities without sequelae but 4 of them developed a keloid scar. Conclusions: Based on our results, we believe that the SCT is a useful test in clinical diagnosis and postoperative monitoring of anterior interosseous nerve compression.
The Cutaneous Branch of the Deep Ulnar Artery
Authors: Postan Daniel , Poitevin Luciano A.
Published: September 2016

Aim: Hypothenar vascular anatomy has been approached by several authors due to its importance in flap design. The aim of this research is to describe the vascular anatomy of the proximal hypothenar eminence (HE), focusing on a cutaneous branch (CB) of the deep ulnar artery and its possible applications to flap designs. Materials and Methods: Fourteen fresh-frozen hands were studied. Red latex solution was injected previous to dissection. Gross dissection was performed under 3× to 6× magnification. The HE was approached through a longitudinal incision at the fourth web space line reaching the proximal wrist crease. A CB of the deep ulnar artery was identified. Its anatomic variations and relationship to the ulnar nerve were registered as well as its anatomic territory. A theoretical flap was designed and transposed to the volar aspect of the wrist and the interthenar region. Results: A constant CB was identified in the sample. Its origin was at the anteromedial aspect of the deep ulnar artery on the first segment of the artery. At this point, the deep ulnar artery passed over the ulnar nerve and the ulnar digital nerve of the fifth finger in 9 of 14 cases. In the remaining 5 cases, the deep ulnar artery passed behind the nerve; in 4 of these cases, the CB passed behind the nerve as well. In 1 case, the deep ulnar artery passed behind the ulnar nerve, but the CB passed over it. The deep ulnar artery origin was located at a mean of 9 mm distal to the pisiform (range, 3-12 mm). The CB origin was identified at a mean of 3 mm distal to the deep ulnar artery (range, 1-6 mm). The CB irrigated the supra-aponeurotic aspect of the proximal half of the HE by 3 to 5 collateral branches. The arterial diameter at its origin was 0.4 mm average and the distance between the origin and the first collateral branch was 9 mm average. This study shows that it is feasible to harvest a hypothenar cutaneous flap based on the CB. This flap may measure up to 7 × 3 cm. We also showed that it could be rotated as a propeller flap to cover a volar interthenar and wrist skin loss or a resected fibrosis. The donor area could be close by first intention. Conclusion: A constant CB from the deep ulnar artery was identified. This artery supplies the proximal half of the HE and features connections proximally and distally. In spite of the anatomic variations of the deep ulnar artery, in almost all of the cases the CB passed anterior to the ulnar nerve. According to the results of this research, a flap based on this CB may be raised to cover the volar wrist and palm in case of recalcitrant carpal tunnel and other deficits of coverage tissue.
Arthroscopic Management of Thumb Base Arthritis
Authors: Wong Clara Wing-Yee , Mak Michael Chu-Kay , Ho Pak-Cheong
Published: September 2016

Background: Thumb base arthritis is a common condition. Arthroscopic or arthroscopic assisted procedures offer better visualisation, less invasiveness and faster recovery than traditional open procedures; it also helps to guide decision making if further treatment is necessary. Methods: A review of cases who received arthroscopic procedures from April 2002 to August 2013 was performed. First carpometacarpal joint arthroscopic debridement was done in 76 patients, and synovectomy was performed in 65 patients (female 51, male 14) with an average age of 56. All patients failed nonoperative care for 6 months. The average follow-up duration was 59 months. 38 cases were Eaton & Littler Stage II, 36 Stage III, I Stage IV and I Stage I. The operation was done under local or regional anaesthesia. Synovectomy, debridement of frayed capsule and radio-frequency ablation were done in all, loose bodies were removed in 25, and thermal shrinkage was done in 30 cases. Post-thermal shrinkage immobilisation was given for 3-6 weeks. 12 cases had smoothening of the bony surface & prominent osteophytes. Results: 69 cases experienced pain relief after the operation. 20 cases had excellent and 14 had good result. Mean grip strength of 88.3% of the contralateral side while pinch power of 81.7%. Kapandji index was 8. DASH score was 26.5%. Patient satisfaction was 77 of 100. There was no complication encountered. 7 patients requested the same operation on the other thumb after the operation. 3 requested repeating the same operation on the same thumb as pain relief lasted only for 1-3 years. Better outcomes were found to be statistically related to bone surface smoothening, or thermal shrinkage and immobilisation for ≥ 4 weeks. Conclusion: Long-term results of arthroscopic debridement and synovectomy, the surgical techniques, and the examples of arthroscopic assisted procedures at the thumb base were demonstrated and discussed. Arthroscopic surgery for thumb base arthritis is a safe and feasible procedure that can provide long-lasting symptom relief.
Clinical Outcomes of Volar Oblique Ligament Reconstruction in Thumb Basal Joint Arthritis
Authors: Kang Jin-woo , Lee Yong-Suk , Shin Seun-Han , Chung Yang-Guk
Published: September 2016

Introduction: Volar oblique ligament (VOL) is known as a primary trapeziometacarpal joint stabilizer. Because ligament laxity is one of most important cause of thumb basal joint arthritis, Eaton and Littler introduced their technique reconstructing VOL as a treatment of that; however, they recommended using this treatment only for Eaton-Littler stages I and II through their study result. We evaluated clinical outcomes of VOL reconstruction applied for patients with stage I, stage II, and even early stage III thumb basal joint arthritis. Material and Methods: We analyzed 21 patients who had undergone surgery for thumb basal joint arthritis in our hospital from May 2011 to October 2014 and had a minimum 12 month follow-up. All patients were women and the mean age at diagnosis was 58.5 years (range, 43-78 years). Six patients were Eaton stage I, 9 were II, and 6 were III. Functional outcome were evaluated using New York Orthopedic Hospital Wrist Scoring Scale, which assessed range of motion (ROM), grip power, radiologic findings, pain, and hand function. The stability of basal joint and progression of arthritis were also evaluated. Wilcoxon rank sum test was used for statistical analysis. The mean follow-up period was 21.6 months (12-56 months). Result: The overall functional results according to New York Orthopedic Hospital Wrist Scoring Scale were 1 excellent, 10 good, 7 fair, and 3 poor. We divided two groups (Eaton stage I, II vs III) and analyzed nonparametric test; however, it did not show a significant difference ( P = .856). Two of 6 patients with stage III osteoarthritis showed poor result. At last follow-up, average grip power was 83.3% of normal side. The stability of VOL-reconstructed basal joint were restored and maintained in 15 of 21 joints. The arthritis was progressed in 4 joints, 1 of 6 Eaton stage I, 1 of 9 Eaton stage II, and 2 of 6 Eaton stage III joints. Conclusion: Our results suggested that VOL reconstruction is a reliable method for management of Eaton stage I and II osteoarthritis and can be applied even in early Eaton stage III osteoarthritis before performing salvage procedures.
The Surgical Strategy for the Treatment of Total Brachial Plexus Avulsion Injury Patient
Authors: Kaiming Gao , Jie Lao , Xin Zhao , Yudong Gu
Published: September 2016

Objective: The total brachial plexus avulsion injury (BPAI) patients were treated in many organizations in the world, but the results reported differ significantly regarding different surgical strategy. Thus, this study aimed to evaluate the outcomes of different methods of nerve transfer and to determine a relatively optimal surgical strategy for treatment of total BPAI patients. Methods: A retrospective review was conducted on 73 patients with total BPAI who were treated with nerve transfer. The elbow flexion was reconstructed in 73 patients with phrenic nerve (PN) or intercostal nerves (ICNs) or contralateral C7 (cC7) transfer. The shoulder abduction was reconstructed in 73 patients with spinal accessory nerve (SAN) or ICNs transfer or both. Elbow extension was reconstructed in 35 patients with ICNs or cC7 transfer. Wrist and finger flexion were reconstructed in 73 patients with cC7 transfer. Wrist and finger extension were reconstructed in 31 patients with ICNs transfer. The mean follow-up period was 7.3 years. Results: The effective recovery rate were 79.5% in elbow flexion, 76.7% in shoulder abduction, 45.7% in elbow extension, 54.8% in wrist and finger flexion, 57.5% in median nerve area sensation, and 38.7% in wrist and finger extension. No significant difference was found in elbow flexion recovery between the patients with PN, ICN, or cC7 transfer. Shoulder abduction was significantly better in patients with SAN combined with ICNs transfer while no significant difference was found between the patients with anterior or posterior approach SAN transfer. Elbow extension was significantly better in patients with ICNs transfer. Entire cC7 transfer achieved significantly better recovery in wrist and finger flexion than partial cC7 transfer. Conclusion: For the treatment of total BPAI patients, we recommend PN transfer for elbow flexion, SAN combined with ICNs transfer for shoulder abduction, ICNs transfer for elbow extension, entire cC7 transfer for wrist and finger flexion, and ICNs transfer for finger extension, whereas for the elder or PN-injured patients, we recommend SAN combined with ICNs transfer for shoulder abduction, entire cC7 transfer for elbow flexion and wrist and finger flexion, and ICNs transfer for elbow extension and wrist and finger extension.
Short-term Effects of 2 Different Orthoses in Pain Relief in Patient With Carpometacarpal Joint Osteoarthritis
Authors: Cantero-Téllez R. , Schwartz Deborah A. , Arias Jean Christophe
Published: September 2016

Introduction: Carpometacarpal (CMC) joint osteoarthritis critically impacts activities of daily living. Pain is the main reason for a consultation to the hand therapy clinic as described in the literature, and conservative treatment, typically an orthosis, is the first intervention of choice. A thumb orthosis is a specific nonoperative palliative treatment for CMC joint osteoarthritis for improving function and comfort. A variety of thumb orthoses are described in the literature, but there is no supporting evidence highlighting the use of a specific orthotic design for short-time effect on pain and function. Purpose of the Study: The study was conducted to compare the short-term effect of 2 different thumb CMC orthoses on pain reduction as a primary outcome and improved hand function as a secondary outcome. Methods: A total of 66 patients were included in the study. One group of 33 patients received a Hybrid orthosis, immobilizing only the CMC joint, and the other group of 33 patients received a thumb orthosis called the “whale,” which immobilizes the CMC and metacarpophalangeal (MP) joints. Both orthotic designs were custom fabricated for each patient. Outcomes measures included the visual analogue scale (VAS) for pain and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH, Spanish version) for function. Results: Differences in pain scores and functional scores were found in both groups after the one-week washout period compared with baseline, but did not differ significantly between the two groups. Outcome for functional score demonstrated both clinically and statistically significant differences between the baseline and 1 week for outcome score for the both groups (p = .001). With respect to pain intensity, the mean pain score decreased from 7.69 to 5.51 for the CMC orthosis (p = .001) and from 7.78 to 5.45 for the CMC/MP “whale orthosis” (p = .001). Conclusion: The present study adds to our therapeutic knowledge base regarding the benefits of 2 different thumb orthotic designs on pain reduction and functional improvement in the first week using orthoses as an exclusive conservative treatment.
Late Nerve Repairs in Brachial Plexus Lesions
Authors: Raimondi Piero , Gilbert Alain
Published: September 2016

Objectives: It is a common opinion that surgical repair of brachial plexus later than 1 year from the lesion cannot lead to real functional results. This is probably true for repair by means of multiple grafts which need specially in root’s lesions a long time for reinnervation: This fact and the frequent delay in repair reduce in a substantial way the possibility to obtain good results in brachial plexus surgery. The continuous development of nerve transfers allowed shortening the time of recovery by means of very distal repairs, near to the mainly motor targets. The shortening of recovery time gives today the possibility to move forward the classical limits for nerve repair. Materials and Methods: The authors present the results obtained in 93 nerve transfers in 52 patients who underwent nerve repair after more than 1 year from the lesion. The series consists of 22 children with obstetric brachial plexus palsy and 30 adults with traumatic brachial plexus lesions all of them repaired after 1 year from the lesion with a maximum delay of 7 years. The nerve repaired by means of late transfers had been the suprascapular, the musculocutaneous, and the axillary. In all the cases, a previous electromyography detected the presence of fibrillation in the muscles that are planned to be reinnervated. Fibrillation is actually considered as a prerequisite to indicate a late nerve transfer. Results: Evaluation of results has been separate between children and adult patients. In adult patients, the results for biceps have been 30% of failures, 42% of partial results (M2/M3−), and 28% of good results (M3+/M4). The results for suprascapular have been 23% of failures, 45% of partial results, and 32% of good results. In children, the results for biceps have been 15% of failures and 85% of good results (<M3+). The results for suprascapular have been 25% of failures, 25% of partial results, and 50% of good results. No result can be reported for deltoid due to the too reduced number of operated cases. Conclusions: Nerve transfers allow in a considerable number of cases to obtain functional results, in some case even after several years of delay. A part for late observed cases we can offer in this way a second option in cases of lack of recovery from primary surgery. Actually nerve transfer is nowadays a new possibility placed in between primary microsurgical repair and classic palliative surgery. Undoubtedly better results have been obtained in children, but surprisingly useful results could be obtained in adults even if in a more reduced percentage of cases.
Long-term Observation of Respiratory Function After Unilateral Phrenic Nerve and Multiple Intercostal Nerve Transfer for Avulsed Brachial Plexus Injury
Authors: Zheng Mou-Xiong , Qiu Yan-Qun , Xu Jian-Guang , Xu Wen-Dong
Published: September 2016

Objective: Either phrenic nerve transfer (PNT) or multiple intercostal nerve transfer (MIT) alone was reported having no significant impact on pulmonary function in short or medium term. But it has rarely been reported whether the combination of PNT-MIT could influence respiratory function in the long term. In this study, pulmonary and diaphragmatic functions were compared between PNT and PNT-MIT after 7 to 19 years (mean 10 years) postoperatively. Methods: Twenty-three adult patients with brachial plexus avulsion injuries (BPAI) who underwent PNT-MIT were compared with 19 corresponding adult patients who underwent PNT only. Pulmonary function testing, phrenic nerve conduction study, and chest fluoroscopy were performed to assess ventilation, diaphragmatic response, and excursion. In the PNT-MIT group, further comparison was performed to investigate whether the number of transferred intercostal nerves and the timing of MIT would influence the results. Results: In PNT-MIT group, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and total lung capacity (TLC) were 73.69%, 72.04%, and 74.81%, respectively, of predicted values without significant differences from the PNT group. Diaphragmatic paralysis permanently existed with hemidiaphragm elevation of 1 to 1.5 intercostal spaces (ICSs) and near one ICS reduced excursion. No statistically significant difference was found between PNT and PNT-MIT groups. Furthermore, in the PNT-MIT group, the transfer of 3 and 4 intercostal nerves resulted in no further decrease in pulmonary function than that of 2 intercostal nerves. No significant difference was found when PNT-MIT was performed at the same stage or at an interval of 1 or 2 months. Conclusions: In the long-term observation, PNT-MIT did not result in additional impairment in respiratory function in adult patients compared with PNT alone. Transfer of 2 to 4 intercostal nerves at 1- to 2-month delay after PNT is a safe method for treating BPAI.
From Menarche to Menopause
Authors: Mendle Jane , Eisenlohr-Moul Tory , Kiesner Jeff
Published: September 2016

Beginning at puberty, prevalence of psychopathology in females changes as their reproductive lives change. Numerous studies show steep increases in psychological problems when girls reach puberty, including spikes in depression, anxiety, aggression, delinquency, self-injurious behavior, suicidality, substance use, disordered eating, school failure, and interpersonal conflict. Clinical symptoms continue to be linked with reproductive events across women’s lives (e.g., the menstrual cycle, childbirth) and drop noticeably after menopause. These patterns are present cross-culturally and documented in numerous Western, industrialized countries, as well as the Middle East, Asia, Africa, and Latin America. Despite this, very few psychological scientists consider the interplay of reproductive change and mental health. In this introduction to the special series, we present a brief discussion of the associations between reproductive change and psychological symptoms, explore the underrepresentation of research on this topic within psychological science, and highlight recent developments in this field.
Class-Modelling Approaches: Advantages over Discriminant Methods for Compliance Verifications
Authors: Oliveri Paolo
Published: September 2016

Our traditional Chemometric Space is undergoing some change at the moment. I have asked a number of different chemometric specialists to provide us with a series of tutorial type articles in which they will describe the theory and practice of a range of chemometric procedures as applied to (near infrared) NIR spectral data. This series of column articles will, I hope, form an invaluable resource for both the novice and experienced NIR spectroscopist given that some of the techniques to be covered are not as yet routinely applied in all laboratories. As always, we appreciate feedback on this new development. – Ed.
Recent advances in the surgical management of rhinosinusitis
Authors: Jaksha Alexandria F. , Weitzel Erik K. , Laury Adrienne M.
Published: September 2016

Rhinosinusitis affects a significant portion of the US population, and its management imposes a substantial burden on the healthcare system. The treatment of chronic rhinosinusitis includes initial medical management prior to consideration of surgical intervention. However, if surgery does become necessary, several factors must be considered in order to optimize outcomes. This review evaluates surgical patient selection, perioperative medical management, and the extent of operative intervention, with the goal of improving surgical results, decreasing the need for revision surgery, and enhancing the patient’s quality of life. Specific variations in patient genotypes and phenotypes will be further explored with regard to their implications on surgical outcomes. Additionally, the evidence behind pre- and post-operative antibiotic and steroid use will be evaluated. Finally, we will review evolving surgical tools and techniques that are currently being utilized for the treatment of specific subsets of rhinosinusitis.
Getting to S: CDK functions and targets on the path to cell-cycle commitment
Authors: Fisher Robert P.
Published: September 2016

How and when eukaryotic cells make the irrevocable commitment to divide remain central questions in the cell-cycle field. Parallel studies in yeast and mammalian cells seemed to suggest analogous control mechanisms operating during the G1 phase—at Start or the restriction (R) point, respectively—to integrate nutritional and developmental signals and decide between distinct cell fates: cell-cycle arrest or exit versus irreversible commitment to a round of division. Recent work has revealed molecular mechanisms underlying this decision-making process in both yeast and mammalian cells but also cast doubt on the nature and timing of cell-cycle commitment in multicellular organisms. These studies suggest an expanded temporal window of mitogen sensing under certain growth conditions, illuminate unexpected obstacles and exit ramps on the path to full cell-cycle commitment, and raise new questions regarding the functions of cyclin-dependent kinases (CDKs) that drive G1 progression and S-phase entry.
FUNCTIONAL CHARACTERISTIC AND CLINIC MANIFESTATIONS OF AIRWAY RESPONSE TO EXERCISE LOAD IN PATIENTS WITH ASTHMA
Authors: Ульянычев  , Ulyanychev Nikolay , Нахамчен  , Nakhamchen Leonid , Приходько  , Prikhodko Anna , Перельман  , Perelman Yuliy , Воропаева  , Voropaeva Ruta
Published: September 2016

The aim of the research was to identify the frequency of development of the syndrome of post-exercise bronchial spasm in patients with asthma against physical load and the study of clinical-functional features of its course. 197 patients (122 women and 75 men) with mild persistent partially controlled and uncontrolled asthma were observed. The mean age of the patients was 36.1±0.73 years old; the mean height was 168.8±0.63 cm; the mean weight was 74.6±1.03 kg. The patients did not have strong obstructive disorders of the ventilation pulmonary function; forced expiratory volume for the first second (FEV1) was 91.6±2.5% from the predicted value. All the patients had clinical-anamnestic test and the assessment of apnoea degree by the scale of mMRC and identification of disease control by validated questionnaire Asthma Control Test; the airway response was evaluated in reaction to dosed physical load calculated and fulfilled at the research complex for ergospirometric studies OxyconPro (VIASYS Healthcare, Germany); basic study of the lung function at the device Easyone-PC (Switzerland) was done. As a result of the study post-exercise bronchial spasm was diagnosed in 18.3% of patients with asthma. Close positive correlation between the baseline FEV1 (in %) and bronchial response to the dosed physical load measured at the first minute of the recovery period (r=0.19; р<0.05) as well as the intensity of the further bronchial response at the 10th minute of the recovery period (r=0.19; р<0.05) was registered. The intensity of bronchial response at the 10th minute of the recovery period in patients with airway hyperresponsiveness to dosed physical load was directly related with the degree of asthma control (r=0.56; р˂0.05). It was found out that the degree of the asthma control correlated with the airway hyperresponsiveness to physical load.
INFLUENCE OF NEUTROPHILIC COMPONENT OF BRONCHIAL INFLAMMATION ON THE LEVEL OF DISEASE CONTROL AND LUNG FUNCTION IN PATIENTS WITH ASTHMA
Authors: Приходько  , Prikhodko Anna , Пирогов  , Pirogov Aleksey , Перельман  , Perelman Yuliy , Зиновьев  , Zinovev Sergey
Published: September 2016

The cell pattern of bronchi inflammatory infiltrate has a significant impact on the course of the disease and may affect the achievement and maintenance of the asthma control. The aim of the study was to determine the influence of neutrophilic component of the bronchial inflammation on the asthma control, lung function and airway responsiveness. 114 patients with mild persistent asthma were assessed upon the level of the asthma control by Asthma Control Test (ACT); lung function (FEV1) by spirometry; airway responsiveness (∆FEV1) to 3-minute isocapnic hyperventilation with cold air (-20ºС) (IHCA) and 3-minute ultrasound inhalation with distilled water (IDW). The cell composition of the induced sputum (IS) was also studied. The patients were divided into groups with low contents of neutrophils in IS (39 people; 1st group) and with high contents of neutrophils (75 people, 2nd group). The contents of neutrophils in the 1st group was 10.9±0.53%, eosinophils – 19.4±2.1%; in the 2nd group – 29.9±1.6% (р=0.0001) and 20.4±1.4% (р=0.66), respectively. By ACT data the people of the 2nd group managed their disease worse than in 1st group (15.0±0.6 and 19.0±0.8 points, respectively; р=0.0001). They also had lower FEV1 (88.0±2.0 and 96.7±2.4%; р=0.009) and more intensive airway response to IHCA and DW (-13.7±1.7% and -11.2±1.9%, respectively) in comparison with the 1st group (-2.7±0.86%; р=0.0001 and -5.3±1.90%; р=0.055). The patients of the 2nd group had a close correlation between baseline neutrophils in IS and ∆FEV1 in response to IHCA (r=-0.22; р=0.045) as well as the content of myeloperoxidase in IS (r=0.31; р=0.0008). A level of myeloperoxidase in IS correlated with ∆FEV1 in response to IDW (r=0.29; р=0.030) in these patients. The increase of neutrophilic component of inflammation in asthma patients worsens the asthma control, lung function and enhances airway responsiveness to exogenous stimuli.
NANO- AND MICRODIMENSIONAL POLLUTION OF THE ATMOSPHERE OF THE RESERVE "BASTAK" CAUSED BY TECHNOGENIC IMPACT OF BIROBIDZHAN CITY
Authors: Соломенник  , Solomennik Sergey , Никитина  , Nikitina Anna , Лонкина  , Lonkina Ekaterina , Ревуцкая  , Revutskaya Irina , Голохваст  , Golokhvast Kirill , Романова  , Romanova Tatyana
Published: September 2016

The results of the research of nano- and microparticles of atmospheric suspensions which were in the snow of Birobidzhan and the Reserve Bastak in the winter of 2013/2014 by means of laser granulometry and mass spectrometry of high resolution with inductively connected plasma are given in the work. It is shown that there are technogenic microparticles (up to 72.4%) of ecologically significant quantities in atmospheric suspensions of Birobidzhan. The influence of combined heat and power plant and motor transportation junctions on qualitative structure of atmospheric suspensions has been revealed. It is noted that the air in Bastak also contains a significant amount (to 66.3%) of particles up to 10 microns. The analysis of qualitative structure of atmospheric suspensions of Birobidzhan confirms its status as a city with the expressed level of microdimensional pollution of the atmosphere. It is important to note that Birobidzhan negatively influences the structure of the atmospheric suspension of the Reserve Bastak.
THE IMPORTANCE OF UNFAVOURABLE FACTORS OF POSTNATAL ONTOGENESIS IN THE DEVELOPMENT OF THE THREAT OF PREMATURE DELIVERY IN THE SECOND TRIMESTER OF PREGNANCY IN WOMEN INFECTED WITH THE HERPES SIMPLEX VIRUS
Authors: Макарова  , Makarova Galina , Ушакова  , Ushakova Elena , Решетникова  , Reshetnikova Larisa , Судаков  , Sudakov Anatoliy , Андриевская  , Andrievskaya Irina , Луценко  , Lutsenko Mikhail , Смирнова  , Smirnova Tatyana , Гориков  , Gorikov Igor , Колосов  , Kolosov Viktor , Метелкина  , Metelkina Irina
Published: September 2016

The features of postnatal development in 160 women with physiologic course of pregnancy and with chronic placental insufficiency in the second trimester of pregnancy in the patients infected with the herpes simplex virus type 1 (HSV-1) were studied. The first group (the control group) included 30 women with physiologic course of pregnancy. The second group had 41 patients with chronic placental insufficiency of herpes etiology. The third group consisted of 89 women with chronic placental insufficiency and the threat of premature delivery caused by HSV-1. It was found out that in neonatal period of development and in the course of the first year of life the patients of the third group unlike the women of the second group oftener had bottle feeding (30.3 and 9.8%, respectively, р<0.05) and the period of breast feeding of less than 6 months (39.3 and 14.6%, respectively, р<0.05), and in the early childhood and infancy there was the combination of chicken pox and Botkin’s disease (39.3 and 7.3%, respectively, p<0.05), as well as enteritis and enterocolitis (28.1 and 7.3%, respectively, р<0.05). The women in the third group unlike the patients of the second group in the early childhood oftener had acute respiratory virus infections (40.4 and 14.6%, respectively, р<0.05) and lymphadenopathy (37.1 and 12.2%, respectively, р<0.05), and in the school and middle age there was algodismenorrhea (34.8 and 12.2%, respectively, р<0.05), cervical erosion (56.2 and 24,4%, respectively, р<0.05), a big number of gynecological operations (21.3 and 4.9%, respectively, р<0.05) and chronic rhinitis (47.2 and 19.5%, respectively, р<0.05). In the third group unlike the second one the signs of the secondary immunodeficiency prevailed. They were revealed through early infecting with VSH-1 (26.9 and 7.3%, respectively, р<0.05%), reactivation (identification of IgM to HSV-1) of chronic herpesvirus infection (21.3 and 4.9%, respectively, р<0.05%), thrush (16.9 and 2.4%, respectively, р<0.05) and relapsing course of Herpes labialis (22.5 and 4.9%, respectively, p<0.05). We suggest an important role of immunodeficiency in pathogenesis of the threat of premature delivery of herpes virus genesis in the second trimester of gestation and the necessity of the use of immunomodulatory medications for its treatment.
THE ROLE OF ESTRADIOL IN THE SUSTENTATION OF FETOPLACENTAL SYSTEM
Authors: Андриевская  , Andrievskaya Irina , Луценко  , Lutsenko Mikhail , Довжикова  , Dovzhikova Inna
Published: September 2016

The aim of the study is to define the role of abnormalities in the formation of estriol hormones in the development of hormonal dysfunction of fetoplacental system. There were examined 39 placentas from women with exacerbation of chronic cytomegalovirus infection at the third trimester of pregnancy and IgG antibody titer 1:1600 and 30 placentas from women with latent CMV infection and titer 1:400. The activity of androstenedione dehydrogenase was found out with histochemical method on cryostat sections of freshly frozen tissues of placentas by Lloyd’s method. The assessment of intensiveness of histochemical reaction was done with cytophotometric method by Scion program. Estradiol in homogenate of placenta was measured with immune-enzyme method. The quantity of nuclei of placenta syncytiotrophoblast in the state of apoptosis was done with cytophotometric method on paraffin sections stained by ISEL method. By the results of the study the exacerbation of CMV infection at the third trimester of pregnancy leads to the decrease of intensiveness of histochemical reaction in placentas to androstenedione dehydrogenase till 32.1±2.88 pixel/mcm2 (at the latent course it is 54.2±4.31 pixel/mcm2, р<0.001), and in homogenate of placenta to the decrease of estradiol till 18443.2±117.53 pmole/l (at the latent course of the disease it is 28977.7±158.13 pmole/l, p<0.001), on paraffin sections in syncytiotrophoblast by the increase of nuclei number in the state of apoptosis till 5.0±0.03% (at latent course of the disease it is 1.2±0.001%, р<0.001) and vacuole formation, which leads to destructive damages of syncytiotrophoblast cytoplasm. The obtained results prove that the exacerbation of CMV infection at the third trimester of pregnancy causes the decrease of estriol hormones formation, which is accompanied by the damage of morphostructure and exchange processes in cell elements of placenta.
ABOUT TRANSLOCATION OF BACTERIA IN PRACTICALLY HEALTHY PEOPLE
Authors: Катола  , Katola Viktor
Published: September 2016

At research of blood plasma by scanning electronic microscopy in group of 67 practically healthy inhabitants of Blagoveshchensk in 77.6% of cases asymptomatic bacteremia, i.e. translocation of elementary bodies of L-forms bacteria was found out and only in 22.4% of the citizens it was not visualized. The same changes were also revealed in 2 practically healthy gold miners working in difficult environment. Presumably, the translocation of elementary bodies of bacteria occurs owing to the moderate infringement of microbic landscape of thick intestines and insignificant dysfunction of intestines barriers, and it inherently proves poor health of respondents.