bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability of the iPad Measurement for Range of Dart-Throwing Motion
Authors: Dohi Yoshihiro , Fujitani Ryotaro , Omokawa Shohei , Tanaka Yasuhito
Published: September 2016

Hypothesis: The dart-throwing motion (DTM) is functionally very important movement from radial extension to ulnar flection of the wrist and the anatomical and biomechanical futures have been demonstrated experimentally. Clinically, there is the only report to be published to describe the method of goniometric measurement for DTM but the reliability of measurement has not been evaluated. We hypothesized that our DTM measurement method using a tablet device and a simple jig can be a more reliable method. Methods: Participants were 10 healthy volunteers for assessing intrarater reliability and 3 examiners for interrater reliability. Range of extension-flexion and DTM were evaluated. Participants moved their wrist in each motion plane on a flat table. During the DTM measurements, their hand was fixed to an isosceles right triangle jig and kept their wrist rotation 45° obliquely on the table, so they moved their wrist freely in a DTM plane on the table. Photo images at each maximum wrist position from right overhead were recorded using a tablet device and the angle was measured by goniometric software launched on the device. Reference points were marked on participant’s skin before recording images according to our protocol. Intraclass correlation coefficients (ICC) were compared to determine intrarater and interrater reliability, using the SPSS software package ( P < .05). Results: All results are shown in Table 1. According to the guideline provided by Landis and Koch, there was substantial intraobserver (ICC = .67, .71) and interobserver (ICC = .77, .72) in flexion and extension, respectively. We observed almost perfect intraobserver (ICC = .92) and substantial interobserver (ICC = .79) in ulnar flexion and substantial intraobserver (ICC = .62) in radial extension in a DTM plane. There was moderate interobserver (ICC = .59) in radial extension in a DTM plane. Conclusion: The results of the study indicate that the measuring method of the range of motion by use of tablet device can maintain fixed reliability or more. Intrarater and interrater reliability of our method of measurement for DTM compares favorably with conventional flexion-extension motion. The recording of photo image can transform a 3-dimensional object to the plane figure and make the measurement easy.
Long-Term Follow-up of Radial Shortening Osteotomy With Nakamura Effect for Kienböck Disease Stage II and IIIA
Authors: Torrano Juan Carlos , Torrano Juan Pablo
Published: September 2016

Objective: Show our results in the treatment of Kienböck disease stage II and IIIA of the Lichtman classification using a radial shortening osteotomy with Nakamura effect. Material and Methods: In all, 20 patients were evaluated with follow-up of 12 to 120 months (mean, 66 months), 14 males and 6 females between 20 to 45 years old. Eleven were with stage II and 9 with stage IIIA Kienböck disease according to the Lichtman classification. All cases were treated with a lateral metafiseal closing wedge osteotomy of the radius with Nakamura effect. We indicate this joint leveling surgery in patients with confirmed stage II or IIIA Kienböck disease with persistent symptoms, ulnar negative variance, and ulnar angle of the articular surface of the radius greater than 25°. Patients were evaluated with Disabilities of the Arm, Shoulder and Hand (DASH) score, range of motion (ROM), Mayo wrist score, radiological controls, grip strength, and visual analogue scale (VAS) score. Results: In all, 20 patients were evaluated in our study, 11 with stage II and 9 with stage IIIA Kienböck disease according to the Lichtman classification. We did a lateral closing wedge osteotomy in the metafisis of the radius with Nakamura effect in all patients. ROM was 92% compared with the contralateral limb. Mayo wrist score mean was of 90 points. The overall results were 5 excellent and 6 good for patients with stage II Kienböck disease, and 4 excellent and 5 good in patients with stage IIIA. All of them returned to normal work and daily living activities and to sports activities as well. Possible complications of this treatment are delayed union or nonunion, ulnar impaction or infection, but we did not have any of them in our group of patients. Conclusion: We present the results of 20 patients with stage II and IIIA Kienböck disease according to Lichtman scale who were treated using a lateral closing wedge osteotomy of distal radius with Nakamura effect. The objective of this surgery is to produce a radial shortening, a decrease in the ulnar tilt of the articular surface of the radius to 20°, a decrease in Lunate strain, and to produce a “vascular shock” near the necrotic Lunate. Patients were evaluated with DASH score, ROM, Mayo wrist score, grip strength, and VAS score. We achieve 100% between good and excellent results with a 45% of excellent outcome and 55% of good outcome. According to these results, we believe radial shortening osteotomy with Nakamura effect is a reliable technique for the treatment of Kienböck disease stage II and IIIA of Lichtman classification. This procedure is technically straightforward with limited risks, its results are comparable with more significant procedures, it saves the Lunate, and we found limited arthritic changes in a few cases.
Denervation of the Wrist
Authors: Martínez Carlos Eugenio , Garay Alberto Luis , Jalaris Daniel , Tonetto Germán , Riva Raúl
Published: September 2016

Introduction: Denervation is a simple alternative for the treatment of chronic pain syndromes of the wrist joint. It is a palliative resource with the limited objective of removing or relieving pain when other treatments attempted have failed to ensure an effective solution. The success of this procedure is based on a specific neurotomy of the articular branches of the nerves that go to the affected joint, without affecting the superficial and deep sensitivity. We present this work to evaluate the indications and outcomes over time of denervation of the wrist in arthritis stage 4. Methods: We performed a retrospective study of 26 patients with complete denervation of one of the wrists and of 36 patients with selective denervation, with a minimum follow-up of 24 months in both groups. Patients in whom denervation was accompanied by another procedure, such as partial fusion, internal fixation, or arthroplasty, were not included in this study. All patients underwent a preoperative test with local injection of lidocaine at 1%. As regards the surgical technique, we used 5 incisions for complete denervation, as was first advanced by Wilhelm and further modified by Foucher. The indications for this procedure were joint degenerative changes, stage 4, caused by navicular pseudarthrosis, Kienböck disease, scapholunate dissociation, and others. Results: The evaluation was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the test for assessing mobility and grip strength as measured by dynamometer comparison. Of 26 patients with complete denervation, 20 (76.92%) showed significant improvement in pain, 16 of whom were discharged without pain (61.53%). In 4 patients (15.38%), the result was moderate, with pain during heavy work. The remaining 2 patients did not show any improvement with the procedure. The 36 patients with selective denervation reported no pain or only mild pain during heavy work. All patients, considering both groups, retained at least the previous mobility and strength of grip, which was increased in many cases, whereas 2 patients had paresthesias in the back of the thumb that disappeared after 12 months. Conclusions: Denervation of the wrist is a simple and palliative treatment, which ensures good results in patients with painful restriction of mobility caused by degenerative changes. To achieve a good result, it is essential to have both an accurate knowledge of the anatomy of the articular branches of the peripheral nerves innervating the wrist and an adequate selection of patients by clinical, radiological, and lidocaine tests.
Wrist Arthroscopy as a Diagnostic Tool in Chronic Wrist Pain
Authors: Mehta Nishank H. , Garg Bhavuk , Kotwal P. P. , Malhotra Rajesh
Published: September 2016

Aims and Objectives: Our study aims to outline and investigate the role of wrist arthroscopy as both a diagnostic and a therapeutic tool in patients with chronic wrist pain. Materials and Methods: Between April 2014 and June 2015, 33 patients with chronic wrist pain undiagnosed with routine x-rays and with clinical suspicion of ligament injuries of the wrist underwent arthroscopic examinations. Both radiocarpal and midcarpal joint spaces were visualized using standard arthroscopic portals. The surgeries were carried out as day care procedures under general anesthesia. Therapeutic interventions as deemed necessary were done in the same sitting. The arthroscopic findings were further correlated with radiological and clinical findings. Results: In the 33 wrists that were arthroscopically examined, 17 lesions of the triangular fibrocartilage complex (TFCC) were found—10 (58.8%) were central perforations which were arthroscopically debrided whereas 7 (41.2%) were tears of the TFCC at its peripheral attachment and were repaired. The treated patients at a mean follow-up period of 7.1 months displayed an improvement in their Mayo wrist scores. A total of 13 scapholunate tears and 7 lunotriquetral tears were seen—which were graded arthroscopically. Partial tears (60%) were treated by thermal shrinkage and ablation while complete tears (40%) underwent open reconstruction. Cartilage defects of varying degrees were also noted in 6 patients. One patient was found to have extensive cartilage damage and was advised wrist fusion. No complications were noted in the follow-up period. Conclusions: Wrist arthroscopy is a potent diagnostic tool and tends to pick up lesions of intrinsic carpal ligaments and the TFCC which are often missed by advanced imaging techniques. It aids in staging of the lesions, thereby guiding their treatment, and provides a host of therapeutic offerings. It may be recommended in cases of chronic wrist pain where the clinical suspicion is strong and the operating team is well-versed with the technique.
Short-term to Long-term Results of Total Wrist Arthroplasty
Authors: Sörensen Allan Ibsen , Axelsson Peter , Sollerman Christer
Published: September 2016

Introduction: The aim of this study was to review our short-term results to long-term results of wrist arthroplasty from 2 centers. Methods and Material: Remotion implant is a modular total wrist joint prosthesis. Uncemented technique used except for 2 cases. The prosthesis used for patients with rheumatoid arthritis in 95 cases, degenerative arthritis in 32, and posttraumatic arthritis in 23. Patients evaluated preoperatively and postoperatively with range of motion (ROM), grip strength, and visual analogue scale (VAS) scores of 0 to 100 mm of pain and satisfaction. Functional and general outcomes were evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient Rated Wrist Evaluation (PRWE) questionnaires. Radiographs were obtained preoperatively and at follow-up. The procedure performed in 159 patients, 47 men and 112 women. Their median age was 61 years (24-86). Diagnosis was rheumatoid arthritis in 95 cases, degenerative arthritis in 32, and posttraumatic arthritis in 23. Median follow-up was 50 months (range, 3-133). Results: Wrist extension and flexion was preoperatively 35/35° and at follow-up 35/30°. Radial/ulnar deviation was 10/25° versus 10/30° postoperatively. Grip strength, in KgF, was preoperatively 10 (range, 0-64) and at follow-up 16 (0-70). VAS pain was preoperatively at rest/activity 43/68, and at follow-up 5/21. QuickDASH and PRWE scores were preoperatively 59 and 66, respectively, and at follow-up 36 and 29. VAS satisfaction preoperatively was 14 mm (0-100) at latest follow-up 87 mm (4-100). No infections or dislocations encountered. Ten prosthesis revised. Arthrodesis in 4 cases and in 6 cases, some of the components revised to new components. Conclusions: The short-term to long-term outcome indicates that total wrist arthroplasty is a viable option with unchanged ROM and improvement of pain, grip strength, QuickDASH, PRWE, and satisfaction. We consider our complication rate more than acceptable.
Wrist Function 1 Year After Complicated Distal Radius Fracture
Authors: Niklasson Johan
Published: September 2016

Objective/Hypothesis: Complicated unstable distal radius fractures with damaged joint surface should be managed by open reduction and internal fixation (ORIF). The currently most common method is to stabilize the fracture with a volar fixed-angle locking plate. Combined volar and dorsal ORIF (Pi-plate method) is an alternative, but few previous studies have investigated the outcome after this method. Aim: The aim of this study was to investigate wrist function according to physical functioning, pain, and patient-rated wrist function 1 year postoperatively in patients who underwent ORIF with the Pi-plate method. It was also analyzed the incidence of complications and hardware removal. Material and Methods: This retrospective study involves 116 patients during 1 year. Follow-up results were available for 88. One was excluded because of bilateral fractures. Results: The average wrist motion was 71% to 94% and grip strength was 79% compared with the uninjured hand. Median pain at rest and activity were 0 and 3 measured by Numerical Rating Scale and wrist function was 19.5 measured by Patient-Rated Wrist Evaluation (PRWE). Patients 60 years or older regained function at the same level as those younger than 60 years. There was a moderate correlation between PRWE score and dorsal/volar flexion and relative grip strength, respectively. None of the patients had tendon ruptures or developed complex regional pain syndrome. Hardware was removed in 44%. Conclusions: The conclusion of this study is that patients undergoing combined dorsal and volar ORIF regain good wrist function without complications but that hardware is commonly removed.
New Ways of Creating Capacity
Authors: O’Brien Lisa , Broom Lisa , Ullah Mohammad Mosayed
Published: September 2016

Objective/Hypothesis: We aimed to determine whether an 8-week online training program for developing skills in short course development and delivery was effective in establishing locally driven, sustainable, evidence-based training for Bangladeshi hand therapists. Materials and Methods: Five Bangladeshi therapists from a rehabilitation center participated in the course, which was facilitated online by an Australian university. They completed 8 prerecorded modules over a 3-month period and were assessed in situ on their ability to deliver a hand therapy tutorial to their peers. A qualitative explanatory case study design was used to evaluate outcomes, drawing on data gathered from precourse, postcourse, and 1-year follow-up surveys, observations (including interactions during the course and final participant presentations), and a postcourse focus group. Results: The course achieved 6 of its 9 objectives, with all participants satisfactorily planning and delivering an evidence-based interactive tutorial to their peers. Participants noted improved competence and confidence in searching for evidence, and developing and executing a teaching plan. This was sustained at 1-year review. The key theme was a shift in participants’ concept of learning from being an expert-driven to a self-driven exercise. Enablers were multimodal teaching techniques, the presence of a local leader, and the establishment of informal peer support. Barriers were logistical issues such as access to reliable Internet services, and late delivery of course materials. Conclusions: Online distance education can be effective in producing sustainable change in practitioner skills in developing countries. Future programs would benefit from a blended learning approach incorporating “face-to-face” instructor contact.
Can 3D-Engineered Gloves Prevent Hand Injury in Hurling? Design, Biomechanical Testing, and Player Feedback
Authors: Harte Daniel , Paterson Abby
Published: September 2016

Objective: Engagement in sport promotes health and well-being but also carries the risk of injury, with hand fractures reported as the most common anatomical area. Hurling has been coined as the fastest field sport in the world and its players commonly sustain hand injuries. Average ball speed has been measured to be 123.6 km/h. In order to devise a glove that offers comfort, support, and freedom of movement, the bespoke capabilities of 3-dimensional (3D) printing will be explored in this study. Materials and Methods: An academic from the area of industrial design and an experienced hand therapist will design a glove for use in hurling. Reference to anatomy, common hurling injuries reported in the literature and the capabilities of 3D printing will assist in the glove design. Laboratory studies will also be completed to ascertain the tensile strength of the material and its ability to offer protection from the impact of hurling sticks and balls. Approximately 12 players will have their “catching” hand imaged using a 3D scanner. These data will produce a 3D printed bespoke glove for each player. The gloves will be trialed during the course of a match and players will complete questionnaires exploring the themes of comfort, support, protection and dexterity. Results: Ethical approval has been received from the Healthcare Trust involved in this study. Laboratory studies and glove prototypes are currently in operation. Testing of the glove and questionnaires from players will be completed in April 2016. Conclusion: The prevention of hand injuries sustained in sports participation is a key area to help avoid presentation at emergency departments, follow-up therapy, time off from work, and, in some cases, surgery. This feasibility study explores the versatility of 3D printing as a potential avenue to improve player compliance in wearing protective sportswear and injury prevention. This is the first step in development of a glove through testing prototypes in a controlled environment. Initially hurling is the primary focus in this study, but knowledge gains should be transferable to other sports that have a high incidence of hand injury.
The Validity and Clinical Utility of the Disability of the Arm, Shoulder and Hand (DASH) Questionnaire for Upper Limb Injuries in Developing Country Contexts
Authors: de Klerk Susan , Buchanan Helen , Jerosch-Herold Christina
Published: September 2016

Objective: South Africa is a developing country with inequality and diversity in terms of culture, language and occupations. The high incidence of violence and trauma contributes to upper limb injuries. Patient rated outcome measures, such as the Disability of the Arm Shoulder and Hand Questionnaire (DASH), should be routinely implemented in order to evaluate the end result of intervention. Specific outcomes of interest are aspects of activity and participation according to the nine domains outlined in the International Classification of Functioning Disability and Health (ICF). This paper will review the evidence available on the validity and clinical utility of the DASH as a measure of activity and participation in patients with upper limb injuries in developing country contexts where inequality exists. Methods: A comprehensive search of key electronic databases, including MEDLINE (PubMed), EBSCOHost, CINAHL, Science Direct, Scopus and Web of Science, will be conducted. Grey literature will also be considered as far as possible. Articles meeting the following inclusion criteria will be included in the review: 1) reporting on the use of the DASH as an outcome measure for upper limb injured patients; 2) from countries with a Gini coefficient of 0.50 and above and; 3) that provide evidence on the validity and clinical utility of the instrument. The methodological quality of selected studies will be independently assessed by two researchers using the critical appraisal tool developed by the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) group. Results: Results will be reported by means of a study flow diagram showing the search strategy. Study characteristics will be summarized including psychometric properties assessed and results. Risk of bias will be assessed and reported using the COSMIN criteria. Conclusion: This review will provide a critical analysis of the psychometric properties of validity and clinical utility of the DASH in traumatic hand injuries assessed in developing countries. Recommendations for practice and future research will be made.
Effects of Selective Activation of the First Dorsal Interosseous and Opponens Pollicis on Thumb CMC Kinematics
Authors: O’Brien Virginia H. , Rosenstein Benjamin , Magnusson Erik , Nuckley David J. , Adams Julie E.
Published: September 2016

Objective: Symptomatic thumb carpometacarpal (CMC) joint osteoarthritis is common. Early data support selective strengthening of the first dorsal interosseous (FDI) and opponens pollicis (OP) muscles for conservative management with improvement in pain and functional outcomes scores. There are limited biomechanical studies to support such strengthening programs. The purpose of these studies was to quantify the kinematics and joint kinetics at the thumb CMC joint during simulated pinch with selective activation of the FDI and OP muscles. The first study was completed with all ligamentous attachments of the CMC joint intact. The second study was completed with all CMC ligaments released. Hypothesis: Our hypothesis was that increased loads in the FDI and OP result in effects to the joint kinematics and reduce subluxation. Results: Our results from both studies show the OP and FDI act synergistically to center the first metacarpal on the trapezium and reduce subluxation during simulated pinch. The OP is the predominant corrective force but tends to overcorrect if unopposed. The FDI tempers the action of OP and contributes to improved CMC congruency. Conclusion: Our conclusion is these biomechanical data support selective thenar muscle re-education and strengthening programs for conservative management of thumb CMC joint osteoarthritis and pain.
Importance of an Integral Rehabilitation Treatment in Patients With Distal Interphalangeal Joint Amputations in the Workplace
Authors: de Paz Andrea , Boffelli Adriana , de las Mercedes Angeleri María , de Conti Maria Cristina G.
Published: September 2016

Objective and Hypothesis: This study seeks to analyze the need and importance of an integral rehabilitation treatment in patients with an amputation of the distal interphalangeal joint in the workplace. Therefore, the major features of such treatment are presented as the therapeutic approach and Mirror Therapy is included among others within the protocol. The concept of integrality involves the physical and functional aspects of the patient as well as the psychosocial ones. Materials and Methods: For the purpose of this descriptive retrospective research, 224 working patients with distal interphalangeal amputations have been examined. All patients either with or without machine operation were evaluated between March 2010 and March 2015 in a hand rehabilitation center in Buenos Aires, Argentina. In addition, other variables among patients have been considered (age, sex, dominance, grip strength, and range of motion (ROM) of the injured hand compared with the healthy hand). Data collection was achieved through patient interviews, medical records, assessment of joint mobility, and grip strength measured by Jamar dynamometer. Results: The analysis of the gathered data evidences the advantages that comprehensive rehabilitation has in patients who suffered distal interphalangeal amputations in the workplace. Results display recovery of strength greater than 100% in most of the interviewees and almost complete recovery of ROM in wrist and fingers, as well as reemployment of the patient without job relocation. Conclusion: Results show the significance of an integral rehabilitation treatment in patients with distal interphalangeal amputations. Such treatment helps patients recover in every facet of life: not just regain joint mobility and strength, but the social and emotional aspects as well, including family and work.
Incidence Reduction of Complex Regional Pain Syndrome Type I After Hand Injury or Hand Operation
Authors: Aasheim Turid , Woje Ann Katrin , Solhjem Ingrid
Published: September 2016

Introduction: The number of hand patients diagnosed with Complex Regional Pain Syndrome type I (CRPS I) has been registered yearly since 2001 by experienced physiotherapists in the hand rehabilitation unit. The Veldman and the Budapest criteria were used as diagnostic criteria. In 2010, we saw an increase in diagnosed CRPS I of nearly 100% compared with previous years. The majority of patients had suffered a distal radius fracture. This coincided with an increase in operative treatment, number of surgeons performing the operations, and a change in the follow-up routines in the hospital and many disciplines involved. We wanted to look into these changes in routines and analyze whether any of these could cause the increase in CRPS I. As many people and disciplines were involved in caring for these patients, we wondered whether they felt they had enough knowledge of the condition of CRPS I. Methods: Medical journals of the registered patients were assessed to identify problem areas. To increase the level of knowledge of signs and symptoms in CRPS I, all staff involved in patient care after hand injury were educated in small multidisciplinary groups by experienced physiotherapists. Written patient information was made available including a telephone number to the hand rehabilitation unit for contact in case of questions, especially on unwanted reactions after trauma and surgery of the hand. Follow-up appointments 14 days postoperatively by physiotherapist were made a part of the routine. Results: In the medical journals, we found no connection between the type of treatment, surgeon or surgical method, and the incidence of CRPS I. Follow-up routines varied for patients who had contacted the outpatient department due to symptoms of excessive pain and swelling. Many patients who had had a change of plaster due to pain and swelling symptoms were referred to physiotherapy, but not all. Increased awareness on unwanted reactions to hand trauma and operation by all staff resulted in quicker referral of patients who needed special care due to symptoms of pain and swelling above the expected level. This resulted in a 50% reduction in the number of patients diagnosed with CRPS I. Conclusions: A well-established referral system and knowledge of CRPS I in the multidisciplinary team seems to reduce the incidence of CRPS I in patients with hand injury and after hand surgery.
Development of a Low Cost, High Function 3D Printed Hand Prosthesis Using the Wrist Extension as Activator
Authors: de Miranda luzo Maria Candida , Pereira Cesar Augusto Martins , Pessa Mariana Miranda Nicolosi , Mattar Rames , de Paula Emygdio Jose Leomil
Published: September 2016

Objective: The authors have developed a prosthesis for hand amputees or malformations that can be activeted mecanically through the moviment of the wrist using the wrist tenodesis pattern and not the the wrist flexion - finger flexion model available. The majority of models for this level of amputation available for free download on the internet, are activated by the the flexion of the wrist, not respecting the physiological and natural sinergical movement of extension of the wrist and flexion of fingers. Method: The 3D prosthesis device is composed by a forearm suport, a hand component with the metacarpals and carpals and four or five fingers, depending on the level of deformity or amputation, polyester lines flex the fingers and elastic bands extend the fingers on a return force and an adjustable traction of the lines that flex the fingers. Results: The invertion of the moving pattern was possible thanks to a mechanism composed by two concentric arcs at the axis of the wrist joint, where one is positioned at the hand and the other on the forearm support. Through a rolling part attached to the hand arc, the finger flexion lines are pulled by the extension of the wrist. The curve ratio of the arcs was projected to use only 20º of extension to produce a displacement of up to 30mm of the flexion lines in relation to the forearm support. This displacement may vary, according to the need, to finger sizes and force needed to perform the activities. Conclusion: Prosthesis prototyped on 3D printers are becoming very known world wide. The possibility of having a low cost device that can improve function and is not meant to substitute the limb, but better, improve the possibilities of action and interaction with the ambient.
The Development of the Interosseous Membrane of the Forearm
Authors: Postan Daniel , Poitevin Luciano A. , Daniel Forlino
Published: September 2016

Aim: The purpose of this research is to study the forearm interosseous membrane (IOM) in embryos and fetal specimens, in order to determine its tissular origin, stage of appearance, and whether there is an early prenatal existence of the fibers and bundles present in adults, such as the central band, the accessory ascendant bundle, and the distal oblique bundle. Materials and Methods: A population of 10 embryos from 7 to 12 weeks (group 1) and 22 fetuses from 12 to 22 weeks (group 2) was studied. Specimens in group 1 were studied by axial sections and histological staining techniques: hematoxylin-eosin, Mallory trichrome stain, and silver stain. The week of appearance of the IOM, as well as the tissue that gave rise to it, was recorded. Specimens in group 2 were studied by anatomical dissections under 6× to 12× magnification and the IOMs were observed by direct and backlighting. The presence of the central band and the oblique ascendant bundle was studied at the proximal membrane. At the distal IOM (distal to the upper limit of the pronator quadratus), the presence of the distal oblique bundle was investigated. Results: We noticed that the IOM developed from the mesenchymal tissue located between the radius and ulna featuring a bridge between both bones at the chondrification stage. This mesenchyma was observed as an extension of the perichondrium of both bones. The mesenchymal bridge withdraws in order to conform to the IOM. We dated this process between the seventh and eighth week (50-56 days). In group 2, we observed the central band fibers. More proximal fibers were noticed earlier, while the distal most were observed in the last weeks. As far as the ascendant oblique bundle, it was seen in the entire group at the posterior surface of the IOM featuring an arrangement similar to the adult. At the distal IOM (distal to the upper pronator quadratus border), we were not able to identify a distal oblique bundle, as in the adult. The distal IOM was thin and displayed just a developing tissue without a distinct organization. Conclusion: The IOM arises from the mesenchymal tissue located between the ulnar and radial perichondrium. This tissue withdraws between the seventh and eighth week, forming the IOM. The gross anatomical features of the proximal fetal IOM are almost the same as in the adult. The central band fibers and the oblique ascendant band were observed. However, the fetal distal IOM did not showed a distal oblique bundle, well developed in most adults. These results might mean that the distal IOM arrangement in the adult is a consequence of the stress-strain forces to which it is subjected during the forearm and wrist movements, while the proximal membrane would follow a preestablished pattern.
Reliability of New Methods to Quantify Forearm Torque and Lifting Strength
Authors: Axelsson Peter , Körrholm Johan
Published: September 2016

Objective/Hypothesis: Forceful forearm rotation and lifting strength are important aspects of upper extremity function. Yet they are rarely assessed in relation to wrist and forearm pathologies, or their treatments. Absence of reliable methods that are easy to use might be one reason for this discrepancy. We designed 2 new procedures to quantify forearm torque and lifting strength in a clinical setting. The objective of this study was to determine the intra- and interrater reliability of these methods. Materials and Methods: We used 2 commercially available dynamometers, the digital Baseline wrist dynamometer and the Kern hanging scale, to develop 2 procedures to measure forearm torque and lifting strength. Two assessors used the new techniques to test 15 healthy volunteers, 10 females and 5 males. Each assessor measured each participant on 3 occasions. Torque was tested for supination and pronation. Lifting strength was tested in 3 forearm positions, supinated, pronated, and neutral position. Analysis of reliability was performed using intraclass correlation coefficients (ICC), with 95% confidence intervals. As raters were fixed ICC model 3 was used with single measurements to determine consistency in agreement. Results: Torque: The intrarater reliability coefficients for test-retest observed for the Baseline dynamometer were for both raters between 0.96 and 0.97 for supination and 0.93 and 0.97 for pronation. There were no differences between the raters ( P < .001). Lifting strength: The intrarater ICCs for the different forearm positions were nearly the same for both investigators (0.95-0.99) and similar values were noted for the interrater comparisons (0.95-0.98). Conclusions: Both the Baseline and Kern dynamometers demonstrated excellent intra- and interrater repeatability. The quality of measurements performed with our new methods is sufficient for future studies of forearm torque and lifting strength. Simple, yet reliable methods to quantify torque and lifting strength in a clinical setting have the potential to improve evaluations of wrist and forearm disorders as well as their treatments.
Fingertip Injuries in Children: Epidemiology, Financial Burden, and Implications for Prevention
Authors: Yorlets Rachel R. , Busa Kathleen , Eberlin Kyle R. , Raisolsadat Mohammad Ali , Bae Donald S. , Waters Peter M. , Labow Brian I. , Taghinia Amir H.
Published: September 2016

Background: Although fingertip injuries are common, there is limited literature on the epidemiology and hospital charges for fingertip injuries in children. This descriptive study reports the clinical features of and hospital charges for fingertip injuries in a large pediatric population treated at a tertiary medical center. Methods: Our hospital database was queried using International Classification of Diseases, Revision 9 (ICD-9) codes, and medical records were reviewed. Frequency statistics were generated for 1807 patients with fingertip injuries who presented to the emergency department (ED) at Boston Children’s Hospital (BCH) between 2005 and 2011. Billing records were analyzed for financial data. Results: A total of 1807 patients were identified for this study; 59% were male, and the mean age at time of injury was 8 years. Most commonly, injuries occurred when a finger was crushed (n = 831, 46%) in a door or window. Average length of stay in the ED was 3 hours 45 minutes, 25% of cases needed surgery, and, on average, patients had more than 1 follow-up appointment. About one-third of patients were referred from outside institutions. The average ED charge for fingertip injuries was $1195 in 2014, which would amount to about $320 430 each year (in 2014 dollars) for fingertip injuries presenting to BCH. Conclusion: Fingertip injuries in children are common and result in significant burden, yet are mostly preventable. Most injuries occur at home in a door or window. Although these patients generally heal well, fingertip injuries pose a health, time, and financial burden. Increased awareness and education may help to avoid these injuries.
Modeling of physical human–robot interaction
Authors: Campeau-Lecours Alexandre , Otis Martin J-D , Gosselin Clément
Published: September 2016

Enhancement of human performance using an intelligent assist device is becoming more common. In order to achieve effective augmentation of human capacity, cooperation between human and robot must be safe and very intuitive. Ensuring such collaboration remains a challenge, especially when admittance control is used. This paper addresses the issues of transparency and human perception coming from vibration in admittance control schemes. Simulation results obtained with our suggested improved model using an admittance controller are presented, then four models using transfer functions are discussed in detail and evaluated as a means of simulating physical human–robot interaction using admittance control. The simulation and experimental results are then compared in order to assess the validity and limitations of the proposed models in the case of a four-degree-of-freedom intelligent assist device designed for large payload.
A comparison of mechanisms for setting generic drug prices in Canada
Authors: Hollis Aidan , Grootendorst Paul
Published: September 2016

Canadian drug plan pricing of generic drugs is in a state of flux, with different plans adopting different approaches. The manner in which public plans pay for generic drugs can affect five policy goals: low generic drug prices, security of the drug supply, a reliance on reimbursement rules (thereby avoiding the need for drug plan managers to exercise discretion over reimbursement levels), low administrative burden and finally, the provision of adequate incentives for generics to enter the market. We review five pricing mechanisms: maximum prices, tiered pricing, tendering, benchmarking and pharmacy competition. We examine international evidence on the success of the first three of these. We conclude with an assessment of promising reimbursement approaches.
Perforator-based propeller flaps reliability in upper extremity soft tissue reconstruction: a systematic review
Authors: Vitse J. , Bekara F. , Bertheuil N. , Sinna R. , Chaput B. , Herlin C.
Published: September 2016

Current data on upper extremity propeller flaps are poor and do not allow the assessment of the safety of this technique. A systematic literature review was conducted searching PubMed, EMBASE, and the Cochrane Library electronic databases, and the selection process was adapted from the preferred reporting items for systematic reviews and meta-analysis statement. The final analysis included ten relevant articles involving 117 flaps. The majority of flaps were used for the hand, distal wrist, and elbow. The radial artery perforator and ulnar artery perforator were the most frequently used flaps. The were 7% flaps with venous congestion and 3% with complete necrosis. No difference in complications rate was found for different flaps sites. Perforator-based propeller flaps appear to be an interesting procedure for covering soft tissue defects involving the upper extremities, even for large defects, but the procedure requires experience and close monitoring.

Level of evidence: II
Autophagy is induced by anti-neutrophil cytoplasmic Abs and promotes neutrophil extracellular traps formation
Authors: Sha Li-Li , Wang Huan , Wang Chen , Peng Hong-Ying , Chen Min , Zhao Ming-Hui
Published: September 2016

Dysregulated neutrophil extracellular traps (NETs) formation contributes to the pathogenesis of anti-neutrophil cytoplasmic Ab (ANCA)-associated vasculitis (AAV). Increasing evidence indicates that autophagy is involved in the process of NETs formation. In this study, we aimed to investigate whether ANCA could induce autophagy in the process of NETs formation. Autophagy was detected using live cell imaging, microtubule-associated protein light chain 3B (LC3B) accumulation and Western blotting. The results showed that autophagy vacuolization was detected in neutrophils treated with ANCA-positive IgG by live cell imaging. This effect was enhanced by rapamycin, the autophagy inducer, and weakened by 3-methyladenine (3-MA), the autophagy inhibitor. In line with these results, the autophagy marker, LC3B, showed a punctate distribution pattern in the neutrophils stimulated with ANCA-positive IgG. In the presence of rapamycin, LC3B accumulation was further increased; however, this effect was attenuated by 3-MA. Moreover, incubated with ANCA-positive IgG, the NETosis rate significantly increased compared with the unstimulated group. And, the rate significantly increased or decreased in the neutrophils pretreated with rapamycin or 3-MA, respectively, as compared with the cells incubated with ANCA-positive IgG. Overall, this study demonstrates that autophagy is induced by ANCA and promotes ANCA-induced NETs formation.
HMGB1 exacerbates experimental mouse colitis by enhancing innate lymphoid cells 3 inflammatory responses via promoted IL-23 production
Authors: Chen Xiangyu , Li Lingyun , Khan Muhammad Noman , Shi Lifeng , Wang Zhongyan , Zheng Fang , Gong Feili , Fang Min
Published: September 2016

In inflammatory bowel diseases (IBD), high mobility group box 1 (HMGB1), as an endogenous inflammatory molecule, can promote inflammatory cytokines secretion by acting on TLR2/4 resulting in tissue damage. The underlying mechanisms remain unclear. Here we report a novel role of HMGB1 in controlling the maintenance and function of intestine-resident group-3 innate lymphoid cells (ILC3s) that are important innate effector cells implicated in mucosal homeostasis and IBD pathogenesis. We showed that mice treated with anti-HMGB1 Ab, or genetically deficient for TLR2–/– or TLR4–/– mice, displayed reduced intestinal inflammation. In these mice, the numbers of colonic ILC3s were significantly reduced, and the levels of IL-17 and IL-22 that can be secreted by ILC3s were also decreased in the colon tissues. Furthermore, HMGB1 promoted DCs via TLR2/4 signaling to produce IL-23, activating ILC3s to produce IL-17 and IL-22. Our data thus indicated that the HMGB1-TLR2/4-DCs-IL-23 cascade pathway enhances the functions of ILC3s to produce IL-17 and IL-22, and this signal way might play a vital role in the development of IBD.
Preparing Practitioners to Conduct Educational Research and Evaluation: What the Research Says and What Our Experiences Taught Us
Authors: Mansfield Katherine Cumings , Stacy Jaime
Published: September 2016

The purpose of this article is to share the insights gleaned from the literature and our on-the-ground realities teaching practitioners to conduct educational research and evaluation. We focus on four areas we have found most important for teaching practitioner-scholars: (a) giving careful attention to andragogy versus pedagogy, (b) engaging the potency that team teaching affords, (c) addressing challenges associated with the practitioner-scholar model, and (d) building on the strengths of the cohort model. We share the challenges and possibilities of each strategy and close by offering recommendations for the educational leadership field in moving forward.
Extreme Political Beliefs Predict Dogmatic Intolerance
Authors: van Prooijen Jan-Willem , Krouwel André P. M.
Published: September 2016

Dogmatic intolerance—defined as a tendency to reject, and consider as inferior, any ideological belief that differs from one’s own—is often assumed to be more prominent at the political right than at the political left. In the present study, we make two novel contributions to this perspective. First, we show that dogmatic intolerance is stronger among left- and right-wing extremists than moderates in both the European Union (Study 1) as well as the United States (Study 2). Second, in Study 3, participants were randomly assigned to describe a strong or a weak political belief that they hold. Results revealed that compared to weak beliefs, strong beliefs elicited stronger dogmatic intolerance, which in turn was associated with willingness to protest, denial of free speech, and support for antisocial behavior. We conclude that independent of content, extreme political beliefs predict dogmatic intolerance.
Multilevel Intergroup Contact and Antigay Prejudice (Explicit and Implicit)
Authors: MacInnis Cara C. , Page-Gould Elizabeth , Hodson Gordon
Published: September 2016

Intergroup contact at the individual level is robustly associated with lower prejudice, but intergroup contact occurs within a greater regional context. Multilevel examinations thus far have focused on interethnic contact, where both individual- and contextual-level contact are associated with lower explicit prejudice. Given that ethnicity is visible, two lingering questions concern whether (a) contextual contact effects only apply to visible outgroups and (b) contextual contact effects predict implicit prejudice in addition to explicit prejudice. In two studies, we tested these questions in the domain of sexual orientation. Individual- and contextual-level contact were simultaneously (uniquely) associated with lower implicit and explicit prejudice: Individuals having more contact with gay men/lesbians were less prejudiced toward gay men and lesbians, and individuals living in areas with greater contact with gay men/lesbians were less prejudiced toward gay men/lesbians. It seems that people need not directly witness intergroup contact in their region for contextual contact effects to occur.
A rare case of pancreatic endometriosis in a postmenopausal woman and review of the literature
Authors: Plodeck Verena , Sommer Ulrich , Baretton Gustavo B , Aust Daniela E , Laniado Michael , Hoffmann Ralf-Thorsten , Platzek Ivan
Published: September 2016

Pancreatic endometriosis is very rare with only a few cases reported in the literature. The imaging features are non-specific and the definitive diagnosis is usually only established after surgery. We report on a 68-year-old woman with left upper quadrant pain who demonstrated a mass in the pancreatic tail on imaging. Laboratory results showed only mildly elevated liver enzymes, tumor markers were within the normal range. A left pancreatectomy was performed, frozen section suggesting a benign lesion, and final histopathology confirmed endometriotic cysts. A research of the literature found only eight reported cases of endometriotic cysts of the pancreas, with the majority affecting premenopausal women. Preoperative diagnosis is challenging and most patients undergo resection because of suspected neoplasm. Thorough diagnostic workup may help in avoiding extensive surgery and reduce postoperative complications.
Further Validation of the SIGMAR1 c.151+1G>T Mutation as Cause of Distal Hereditary Motor Neuropathy
Authors: Lee Jessica J. Y. , van Karnebeek Clara D. M. , Drögemoller Britt , Shyr Casper , Tarailo-Graovac Maja , Eydoux Patrice , Ross Colin J. , Wasserman Wyeth W. , Björnson Bruce , Wu John K.
Published: September 2016

Distal hereditary motor neuropathies represent a group of rare genetic disorders characterized by progressive distal motor weakness without sensory loss. Their genetic heterogeneity is high and thus eligible for diagnostic whole exome sequencing. The authors report successful application of whole exome sequencing in diagnosing a second consanguineous family with distal hereditary motor neuropathy due to a homozygous c.151+1G>T variant in SIGMAR1. This variant was recently proposed as causal for the same condition in a consanguineous Chinese family. Compared to this family, the Afghan ethnic origin of our patient is distinct, yet the features are identical, validating the SIGMAR1 deficiency phenotype: progressive muscle wasting/weakness in lower and upper limbs without sensory loss. Rapid disease progression during adolescent growth is similar and may be due to SIGMAR1’s role in regulating axon elongation and tau phosphorylation. Finally, the authors conclude that SIGMAR1 deficiency should be added to the differential diagnosis of distal hereditary motor neuropathies.