Japanese version of the Patient-rated elbow evaluation score correlates with physician-rated Japanese orthopaedic association-Japan elbow society elbow function score

BACKGROUND

The association between Patient-Rated Elbow Evaluation: Japanese version (PREE-J) and Japanese Orthopaedic Association-Japan Elbow Society Elbow Function score (JOA-JES score) is unclear. This study evaluated the association between PREE-J and JOA-JES scores.

METHODS

The patients with elbow disorders were divided into two groups: Group A (conservative treatment, n = 97) and Group B (surgical treatment, n = 156). The patients were also divided into four disease subgroups according to the JOA-JES classification (rheumatoid arthritis, trauma, sports, and epicondylitis groups), and the association between PREE-J and JOA-JES scores in each disease category was examined. In group B, associations between PREE-J and JOA-JES scores were examined pre-and postoperatively.

RESULTS

In group A, there were significant associations between PREE-J and JOA-JES scores. In group B, a strong association between preoperative PREE-J and JOA-JES scores was observed in all disease categories. There was also a significant association between postoperative PREE-J and JOA-JES scores. Additionally, group B showed significant postoperative improvements in PREE-J and JOA-JES scores.

CONCLUSIONS

The PREE-J score correlates well with the JOA-JES score and reflects treatment response before and after treatment.

Radial Osteotomy With Callus Distraction for the Correction of Severe Madelung Deformity

We report a case of an 11-year-old girl with bilateral severe Madelung deformity who underwent radial osteotomy with callus distraction. The distal radial articulation was corrected at surgery, and a unilateral fixator was subsequently used for callus distraction. No postoperative complication was noted. The patient did not need any additional surgeries for correction of the deformity. Forty-three months after surgery, the patient had a nearly full range of motion without any pain. Forearm deformity was not noticeable, except for surgical scar on both wrists.

Midterm surgical outcomes of duplicated thumbs according to new classification

BACKGROUND

Surgical outcomes of duplicated thumbs differ depending on the branching type. We developed a new classification system and report surgical outcomes with an average 10.2-year follow-up.

METHODS

A total of 529 patients with 562 duplicated thumbs were reviewed. We compared surgical anatomies and X-rays, and then developed a new classification system, based on the branching level and particular bone shape observed via X-ray; D-type included Wassel types I and II, and P-type included Wassel types Ⅲ and Ⅳ and four types of subdivisions, Po, Pa, Pb, and Pc, according to particular bone structure. The MC-type included Wassel types V and VI. All hands were assessed using the Japanese Society for Surgery of the Hand (JSSH) evaluation form, and factors causing poor outcomes were analyzed.

RESULTS

There were 25% D-type, 59% P-type, and 14% MC-type hands, and 2% of hands were not classified. Overall, 351 hands (63%) were directly assessed when the patients reached 5 years of age. A total of 17% of hands were fair. Good results were shown for 90% of D- and Po- type hands. Pa-, Pb-, Pc-, and MC-type hands had lower JSSH scores than D- or Po-type hands. Pa- and Pb-type hands tended to develop interphalangeal joint malalignment and instability, while Pc- and MC- type hands developed disorders in the metacarphophalangeal joint with growth.

CONCLUSIONS

Through a new classification system, we clarified the potential pitfalls for each type of duplicated thumb. More than 90% of D- and Po- type hand obtained good results. Care should be paid of interphalangeal joint reconstruction for Pa-and Pb-type hands, while meticulous reconstruction of metacarpophalangeal joint was essential for Pc- and MC-type hands. Analyzing this large cohort of duplicated thumbs provides important information for surgeons and patients.Type of study of evince: Therapeutic IV.

Gartland Type III Pediatric Supracondylar Humerus Fracture with Radial Nerve Laceration: A Case Report

CASE

A 6-year-old boy sustained complete radial nerve palsy with a Gartland type III supracondylar humerus fracture (SCHF). Posteromedial displacement of the distal fragment was so severe that the tip of the proximal fragment protruded subcutaneously at the anterolateral aspect of the antecubital fossa. Immediate surgical exploration was performed to reveal radial nerve laceration. Neurorrhaphy after fixation of the fracture resulted in full recovery of radial nerve function 1 year postoperatively.

CONCLUSIONS

Severe posteromedial displacement with complete radial nerve palsy may warrant acute surgical exploration even in a closed SCHF because primary neurorrhaphy may achieve better results than late reconstruction.

Quality Improvement at the Laboratory’s Specimen Reception Station

Introduction/Objective

In our 1000-bed acute care tertiary hospital, physicians order laboratory tests via the computerized-provider-order-entry (CPOE) system and print barcode labels (patient demographics/tests ordered) at the computer-on-wheel printer. When tubes with unsuitable barcodes (misaligned, poor quality) are received at the laboratory specimen reception area a fresh barcode is re-printed by our laboratory staff. An incident involving a re- printed barcode label pasted on the wrong blood tube prompted an investigation into the quality of barcodes.

Methods/Case Report

We initiated ‘an opportunity for improvement (OFI) project’ at the laboratory specimen reception station. The OFI team involved Nursing, Information Technology (IT) and Pathology departments aimed to eliminate re-printing of barcode labels by 75% within 6 months. We collated and analyzed reasons for re-printing of barcodes on 3 separate 48-hour periods (27-28 April 2020, 24-25 June 2020, and 13-14 June 2022). A series of interventions and initiatives were implemented.

Results (if a Case Study enter NA)

Re-printed barcodes were from the Emergency Department (56%), Out-patient clinics (7%) and Wards (57%). Root cause analysis(RCA) using the “5 whys” technique categorized re-print causes into staff-related (misaligned barcodes) and printer-related (faint barcodes lines/truncated un-verifiable patient demographics). The team mass-emailed clinicians an educational “Do-You-Know” guide on proper pasting of barcodes on blood tubes and instructions on how to obtain help for printer rectification. These guide documents were placed in the hospital-wide document-sharing portal - Docupedia. Immediate close follow-up with sites that had poor barcodes was done in real-time. Barcode reprints decreased 83% within 2 months - from 174 (27-28 Apr 2020) to 30 (24-25 Jun 2020). A recent audit showed sustained elimination of barcode re-printing: 25 cases (13-14 Jun 2022).

Conclusion

The OFI project has successfully raised the quality of CPOE labels on specimen tubes contributing to process efficiency and safer patient care. Close communication with all care sites and their representatives on the OFI team are critical success factors.

Higher long-term mortality in patients with concomitant acute coronary syndrome and aortic stenosis

Background

Aortic stenosis (AS) and acute coronary syndrome (ACS) share similar cardiovascular risk factors, and their concomitant presentation is increasing in incidence with the aging population. Yet literature regarding the prognosis of patients with concomitant ACS and AS remains scarce.

Methods

This retrospective cohort study examined consecutive patients presenting with ACS (ST-segment elevation myocardial infarction [STEMI] and non-STEMI [NSTEMI]) and concomitant AS between 1 January 2011 and 31 March 2021 in a tertiary hospital. The cohort was divided into mild, moderate and severe AS based on index echocardiogram. The primary outcome was all-cause mortality. Kaplan-Meier curves were constructed to compare all-cause mortality among the three groups of patients, based on ACS type and left ventricular ejection fraction (LVEF). Multivariable Cox regression was performed to identify independent predictors of all-cause mortality.

Results

Of a total of 563 patients, 264 had mild (46.9%), 193 moderate (34.3%) and 106 severe AS (18.8%). The mean follow-up duration was 2.5 (± 2.4) years. Majority of patients (72.5%) presented with NSTEMI. Patients with moderate and severe AS had higher rates of all-cause mortality compared to those with mild AS (49.7% vs. 51.4% vs. 35.6% respectively, p=0.002). Concomitant moderate (HR 1.439, 95% CI 1.012–2.048, p=0.043) and severe AS (HR 1.844, 95% CI 1.159–2.933, p=0.010) were independent predictors of all-cause mortality after adjusting for age, gender, LVEF, ACS type, chronic kidney disease, diabetes, hypertension, coronary artery bypass grafting and aortic valve replacement as a time-dependent variable. The Kaplan-Meier curves demonstrated excess mortality in moderate and severe AS, compared to the mild AS group (p<0.001), with similar survival trends observed in the STEMI and the NSTEMI groups, as well as those with preserved LVEF.

Conclusion

Regardless of the ACS presentation type, long-term excess mortality in those with concomitant moderate or severe AS was observed. The adverse prognosis typically observed in patients with concomitant severe AS, in the setting of ACS, extends to patients with moderate AS.

Funding Acknowledgement

Type of funding sources: None.

Differences in Coagulation and Haemostatic Parameters in Normal Women of Childbearing Age from Different Ethnic Groups and Geographical Locations

A comparative study of coagulation and fibrinolytic laboratory parameters was undertaken in four countries (Salvador, Brazil; Singapore; Santiago, Chile and Dublin, Ireland) among apparently healthy women of reproductive age. A continuous external quality control scheme of the laboratory measurements was employed to permit comparison among centres. Significant and consistent differences were found between the four centres. In Dublin, the prothrombin time and activated partial thromboplastin time (APTT) were accelerated, and the specific factor assays showed more activity, whereas the antiprotease levels were higher than in the other centres. In Salvador, a contrasting tendency was found with longer prothrombin times and APTT and lower Factor VII and antiprotease levels. The results from the other two centres were approximately midway between these two extremes. The study has revealed important differences in the coagulation and haemostatic tests between women from widely diverse geographical areas. It is not certain whether these are due to ethnic, nutritional or economic factors but they may be related to the apparent varying incidence of thrombosis in these ethnic groups.

Mid- to long-term outcomes after surgical treatment of chronic anterior dislocation of the radial head in children

BACKGROUND

To evaluate the mid- to long-term clinical and radiographic outcomes after surgical treatment of chronic anterior dislocation of the radial head in children.

METHODS

Open reduction was performed in 16 children (mean age, 9.3 years [range, 2.6-13.6 years]) with chronic anterior dislocation of the radial head. Twelve patients had a history of preceding injuries, with a mean interval between injury and surgery of 24 months (range, 2-86 months); 4 patients did not have injuries. Eight patients who had undergone reduction within 16 months were treated by open reduction and ulnar osteotomy. The other 8 patients who had not sustained trauma or had been injured >2 years previously required either annular ligament reconstruction or radial shortening in addition to ulnar osteotomy.

RESULTS

The average preoperative Kim's elbow performance score was 77.2 ± 10.5, which significantly improved to 97.5 ± 5.8 at the final follow-up. The radial head was maintained in a reduced position in 14 patients and was subluxed in 2. Slight osteoarthritic changes of the elbow were observed in 2 patients with good reduction. The functional results were excellent in 15 and were good in 1 patient with an average follow-up of 6.5 years (range, 2.6-15.1 years).

CONCLUSIONS

Our surgical procedure provided good mid- to long-term clinical and radiographic outcomes.

Effectiveness of antibacterial prophylaxis with non-absorbable polymyxin B compared to levofloxacin after allogeneic hematopoietic stem cell transplantation

BACKGROUND

Fluoroquinolones are widely used for antibacterial prophylaxis during neutropenia following hematopoietic stem cell transplantation (HSCT). Nevertheless, data are inadequate as to whether fluoroquinolones decrease mortality rate compared with other antibiotics.

METHODS

We retrospectively compared the efficacy of antibacterial prophylaxis using non-absorbable polymyxin B (PB) (n = 106) or systemic levofloxacin (LVFX) (n = 140) after allogeneic SCT at our institute between 2004 and 2013.

RESULTS

No significant difference was observed between the 2 groups in the cumulative incidences of failure of prophylaxis (P = 0.21), clinically documented infections (P = 0.70), or non-relapse mortality within the first 100 days after transplantation (P = 0.42). With bacteremia, the rate of resistance to LVFX was 82% in the PB group and 100% in the LVFX group (P = 0.41). Also, no significant difference was found in overall survival between the 2 groups (P = 0.78).

CONCLUSION

Our results indicate no difference in the effectiveness of antibacterial prophylaxis between systemic antibiotic LVFX and non-absorbable antibiotic PB.

Flexor pollicis longus reconstruction using the palmaris longus in anterior interosseus nerve syndrome

In anterior interosseus nerve syndrome, reconstruction of the paralyzed flexor pollicis longus is occasionally required. Traditionally, the brachioradialis has been used as a motor, but we utilised the palmaris longus, which is expendable. The palmaris longus tendon was transferred in an end-to-side manner, leaving the flexor pollicis longus in situ. The procedure was performed in three patients. All patients regained a full range of thumb interphalangeal joint motion and an average 90% of the pinch strength. The only complication noted was thenar pain due to the adhesion of the palmar branch of the median nerve with the transferred tendon in one patient. This can be avoided if the interlacing suture was placed more proximally. Palmaris longus transfer is a simple technique that gives a satisfactory result.

5 DISRUPTION OF THE HIGH MOBILITY GROUP AT-HOOK 2 (HMGA2) GENE IN SWINE REDUCES POSTNATAL GROWTH

The high mobility group AT-hook 2 (HMGA2) protein has been shown to be a crucial gene for cell growth, proliferation, and apoptosis; HMGA2 is also a strong biological candidate for growth, because mutations in this gene alter body size in mice and humans. Compared with wild-type controls, adult mice lacking HMGA2 are 60% smaller, and adult heterozygous mutants are 20% smaller. In humans, HMGA2 has been associated with adult and childhood height without any other deleterious effect. Additionally, a microdeletion in the HMGA2 gene in a human patient resulted in short stature, with no dysmorphologies and normal puberty. In order to determine the effect of HMGA2 on fetal and adult growth in pigs, a transgenic pig line deficient in HMGA2 expression was generated by gene targeting in fetal fibroblasts (FF). Using a targeting vector carrying a reporter gene, and homology arms specific to HMGA2, heterozygous mutant cell lines were generated. The cell lines were then used to generate 6 heterozygous females by somatic cell nuclear transfer (SCNT). Bodyweights and lengths from snout to base of tail were measured every 2 weeks for a year for mutant (n = 6) and wild-type farm gilts (n = 6). Data were analysed by one-way ANOVA. As in mice, disruption of one allele of the HMGA2 gene resulted in 25% reduction in weight (P < 0.0001) and 14% reduction in length (P < 0.0001). Early in postnatal growth (2 months), weights of mutants were not different than wild-type. However, mutants were 20 to 35% lighter (P < 0.05) during mid stages (6 months) and 25 to 30% (P < 0.0001) in late stages (3 months). The same insertional mutation generated 8 heterozygous male clones by SCNT. In addition, 7 nontransgenic males from the same FF line were generated as SCNT controls. Bodyweights and lengths were measured every 2 weeks for 30 weeks for HMGA2 heterozygous mutants (n = 8), control SCNT (n = 7) and wild-type farm boars (n = 5). The weight curve of boars showed similar pattern as for mutant gilts. At 30-week postnatal stage, mutants were 17% (P < 0.05) and 16% (P < 0.05) lighter in weight compared with littermate and wild-type animals, respectively. We are presently developing homozygous HMGA2 mutant lines. Currently, 3 of 6 heterozygous gilts have been bred with heterozygous boars, with 1 confirmed pregnancy. The expectation is that the homozygous animals will, like mice, be 60% smaller than the wild-type animals. The approach described here will result not only in a valuable large-animal model of dwarfism, but also in a tool to reduce the size of existing transgenic and nontransgenic swine lines. This, in turn, will increase the receptivity of valuable transgenic lines by the biomedical community. Funding for this work was provided by NIH grant R21-OD010553 to JP.

ARTHROSCOPIC VISUALISATION OF THE DISTAL RADIOULNAR JOINT

The diagnosis of chronic wrist pain is challenging and wrist arthroscopy has been recognised as the "gold standard". The present study investigated the efficacy of adding distal radioulnar joint (DRUJ) arthroscopy to routine wrist arthroscopy. The records of 67 patients who underwent DRUJ arthroscopy were reviewed, and the success rates for visualisation of intra-articular structures were determined. Pathological findings were correlated with ulnar-side wrist pain. In seven patients, pre-operative diagnoses were altered after DRUJ arthroscopy. The ulnar head and proximal surface of the triangular fibrocartilage complex (TFCC) were visualised in 100% and 99% of patients, respectively, while the foveal insertion of TFCC and sigmoid notch were visualised in 57% and 69%, respectively. Pathological findings of the proximal surface of TFCC tended to relate to ulnar wrist pain (p = 0.06). DRUJ arthroscopy should be included in routine wrist arthroscopy to enhance the accuracy of diagnosis.

Radial osteotomy for Kienböck disease

Of various surgical treatments, radial shortening for patients with negative ulnar variance and radial wedge osteotomy (radial closing osteotomy) for patients with 0 or positive ulnar variance are widely accepted for the treatment of Kienböck disease. Long-term follow-up studies have shown more than 10 years lasting satisfactory pain relief, as well as an increase in wrist range of motion and grip strength. As representative surgical procedures, the techniques of radial shortening by transverse osteotomy, using a locking compression plate for internal fixation, and radial wedge osteotomy by step-cut osteotomy, using a small dynamic compression plate or locking compression plate, are described. One important point of radial wedge osteotomy is that resection of simple wedge bone yields a decrease in ulnar variance; therefore, we recommend trapezoidal bone resection with ulnar height of 1 mm for transverse osteotomy at the metaphysis and ulnar height of 2 mm for step-cut osteotomy at the distal fourth of the radius.

Reliability of Lichtman's classification for Kienböck's disease in 99 subjects

PURPOSE

The objective of this research was to investigate the reliability of Lichtman's classification for Kienböck's disease.

METHODS

Interobserver reliability and intraobserver reproducibility were investigated by interpreting both anteroposterior and lateral X-rays of the wrist joint twice in 99 patients with Kienböck's disease using the modified Lichtman's classification system. Observers comprised three orthopaedic surgeons, and no information was exchanged between observers either before or during the study.

RESULTS

Intraobserver reliability was moderate (0.313-0.628), and interobserver reliability was fair (Siegel's kappa = 0.228).

CONCLUSION

Low values were obtained regarding interobserver reliability for the modified Lichtman's classification of Kienböck's disease. This classification is thus inadequate for use in clinical settings. A new classification should be established.

Formation of TiSi2 During Rapid Thermal Annealing: In Situ Resistance Measurements at Heating Rates From 1°C/S to 100°C/S

In VLSI technology, there is interest in monitoring the sequence of phase formation of TiSi2 (c-Ti ⇒ a-TiSi ⇒ C49 TiSi2 ⇒ C54 TiSi2), with the prospect of reducing the temperature of formation of the stable C54 TiSi2 phase. In this study, phase formation characteristics of TiSi2 during rapid thermal annealing(RTA) of Ti-Si bilayers are investigated by means of in situ four point probe resistance measurements. Ex situ X-ray diffraction(XRD) was used for phase identification and characterization. Results indicate that the same multi-step sequence of transformations precede the formation of the C54 TiSi2 phase for heating rates from 1°C/s to 100°C/s. Also, all intermediate and metastable phases which occur at l°C/s also occur at 100°C/s. Temperature dependence and kinetics of the C49 TiSi2 and the C54 TiSi2 phase formation were studied over a wide range of heating rates. Activation energies estimated for the two processes were ∼2eV and ∼5eV respectively. Finally, a new Electrical Thermal Annealing(ETA) technique for heating at rates up to 30000°C/s is introduced. Preliminary in situ resistivity measurement results of TiSi2 formation at these high heating rates are also presented.

Pollicization after radical resection of diffuse arteriovenous malformation of the thumb--a case report

A case is presented of arteriovenous malformation of the thumb, requiring thumb amputation and free fap coverage for curative treatment. The thumb was reconstructed by pollicization of the index finger as a secondary operation. The patient remains free of recurrence after 2 years and uses the pollicized thumb for daily activities.

Biodegradation of 2,4-Dichlorophenol through a Distal meta-Fission Pathway

Alcaligenes eutrophus JMP222, a derivative of A. eutrophus JMP134 which has lost plasmid pJP4 (encoding the tfd genes for the ortho fission pathway), was induced for the meta fission pathway when grown on o-cresol. Resting cell suspensions, grown on o-cresol, oxidized 2,4-dichlorophenol (2,4-DCP), a degradation product of 2,4-dichlorophenoxyacetic acid, to 3,5-dichlorocatechol. Further degradation of 3,5-dichlorocatechol was observed by the production of a yellow ring fission product with liberation of chloride. Oxidation of 2,4-DCP (305 (mu)M) in 47 hs resulted in 69% dehalogenation through this pathway. The ring fission product was characterized as 2-hydroxy-3,5-dichloro-6-oxo-hexa-2,4-dienoic acid by gas chromatography-mass spectrometry and gas chromatography-Fourier transform infrared spectroscopy. These data indicate that 2,4-DCP is degraded through a distal meta ring fission pathway, in contrast to either a suicidal proximal fission or the standard ortho fission pathway.

Trigger digits in diabetes: their incidence and characteristics

The purpose of this study was to investigate the incidence and characteristics of trigger digits in patients with diabetes. A questionnaire about trigger digit was completed by 544 patients with diabetes. Ten percent of the patients had a history of trigger digits and 4% had multiple digit involvement. The risk was significantly higher in insulin-dependent patients. The average duration of diabetes was significantly longer in the multiple digit group. Independently, the medical records of 132 trigger digit patients who underwent surgery were reviewed. Twenty-seven patients had diabetes, and 62 patients had multiple digit involvement. Involvement of more than three digits was significantly related to co-existing diabetes. In patients with diabetes, the incidence of trigger digits was about four times higher than in the general population. Screening for diabetes may be warranted in patients with involvement of more than three digits.

Accuracy of amplitude integrated EEG in a neonatal cohort

OBJECTIVE

To determine the sensitivity and specificity of amplitude integrated electroencephalogram (aEEG) compared to simultaneous standard electroencephalogram (sEEG) for seizure detection and background discontinuity.

DESIGN

Prospective paired cohort.

SETTING

Tertiary academic neonatal intensive care unit.

PATIENTS

Infants were recruited from 2005 to 2008. Neonates requiring sEEG were recruited for simultaneous aEEG.

INTERVENTIONS

Following sEEG and aEEG, seizures were recorded as present or absent, and background was recorded as normal or discontinuous in each format.

MAIN OUTCOME MEASURES

Presence of at least one seizure during recording. The background activity was reported as normal or discontinuous. Discontinuity of brain activity was further ranked as mild, moderate or severe.

RESULTS

51 sEEG and aEEG studies were completed. 44 studies were analysed for presence of seizures and 46 were analysed for background discontinuity. Sensitivity for presence of seizures by aEEG was 80% and specificity was 50%. The proportion of infants with seizures were overdiagnosed by aEEG (63.6% vs 45.5% for sEEG p=0.045). Discontinuity of background activity had higher sensitivity (88.6%) and specificity (54.5%) when compared with seizure detection. When stratified by indication for EEG, hypoxic episode (n=14) or suspected seizures (n=33), similar sensitivity for presence of seizure (80%) was noted by aEEG and sEEG. However the specificity of aEEG for seizure detection was higher in neonates undergoing EEG for suspected seizures (66.7% vs 22.2%).

CONCLUSIONS

Background abnormalities were detected with fair accuracy by aEEG but aEEG criteria alone would result in the overdiagnosis of neonatal seizures. Therefore seizures noted on aEEG require sEEG confirmation prior to implementing anticonvulsant therapy for neonatal seizures.

Novel polysaccharide-derived hydrogel prevents perineural adhesions in a rat model of sciatic nerve adhesion

We investigated the effects of a novel carboxymethylcellulose (CMC)-derived hydrogel, in which phosphatidylethanolamine (PE) was introduced into the carboxyl groups of CMC, for preventing perineural adhesion after extensive internal neurolysis of rat sciatic nerve. Sciatic nerves were randomly assigned to one of the following groups: the Control group, operated but no treatment; the HA group, operated and treated with 1% hyaluronan; the CMC-PE(L) group, operated and treated with low-viscosity CMC-PE hydrogel; and the CMC-PE(H) group, operated and treated with high-viscosity CMC-PE hydrogel. Perineural adhesions were evaluated at 6 weeks. Nerves were also subjected to biomechanical testing to assess ultimate breaking strength. Electrophysiological and wet muscle weight measurements were performed. Breaking strengths were significantly lower for the CMC-PE(L) group than for the Control and HA groups. Latency was significantly longer for the Control group than for the CMC-PE(L) group at 20 days. The mean percentage of wet muscle weight to body weight was significantly lower for the Control group than for the CMC-PE(L) group at 6 weeks. Low-viscosity CMC-PE hydrogel appears to prevent perineural adhesions and allow early restoration of nerve function.