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Overexpression associated with F-Box Nictaba Encourages Security and also Anthocyanin Deposition inside Arabidopsis thaliana After Pseudomonas syringae Contamination.
Background Some patients with a confirmed diagnosis of carpal tunnel syndrome (CTS) on clinical examination and electrodiagnostic testing (EDX) may also have one or more clinical features of pronator syndrome (PS). However, the EDX is negative for PS. We label these patients as suspected concurrent carpal tunnel and pronator syndrome (CCPS). We suspect that this is a presentation of reverse double crush syndrome that occurs when a symptomatic distal compression neuropathy converts an asymptomatic proximal compression into a symptomatic one. We believe both compressions can be relieved by decompressing the median nerve only at the wrist. The aim of our study is to determine whether carpal tunnel release (CTR) is an effective treatment for patients suffering from CCPS. Methods This is a prospective, cohort study of the outcomes of CTR in two matched groups with 37 patients in each group. Group A included patients with suspected CCPS and group B included patients with isolated CTS. All patients were evaluated pre-operatively and 1 year after surgery using the Boston Carpal Tunnel Questionnaire (BCTQ). At one year, patients were also assessed for residual symptoms and positive provocative tests. Results A significant improvement in the symptom and functional severity scales (SSS and FSS) of the BCTQ was noted in both groups. The degree of improvement in SSS was similar in both groups; however, group A showed a greater improvement in FSS. This could be attributed to higher pre-operative values in some items of FSS in group A. No patients in either group had residual symptoms severe enough to necessitate further treatment. Conclusion The outcomes of CTR are similar in patients with isolated CTS and suspected CCPS and a CTR may be sufficient to address symptoms of CTS and PS in patients with CCPS. Level of Evidence Level II (Therapeutic).Background Proximal interphalangeal joint (PIPJ) arthroplasty using a Swanson implant is commonly used for the treatment of PIPJ arthritis despite newer implants being available. Many patients develop arthritis in more than one digit and some tend to have multiple digits operated on in their lifetime. There is paucity of literature on the outcomes of multiple PIPJ arthroplasty in one sitting. The aim of this study is to determine the outcomes of PIPJ arthroplasty using a Swanson implant done for multiple digits at one sitting. Methods We retrospectively reviewed the outcomes of multiple Swanson PIPJ arthroplasty during a single operation from 2008 to 2018 in 13 patients (43 arthroplasties). We compared pre- and post-operative results of flexion/extension arcs, grip and pinch strength and questionnaires subsequently compared QuickDASH (Disabilities of Arm, Shoulder and Hand), Patient Evaluation Measure (PEM) and Visual Analogue Score (VAS) scores. Data were analysed with a Mann-Whitney U test. Results Patients on average attended 5.6 hand therapy sessions over 5.1 months post-operatively. Average flexion/extension arc improved from 31.9° pre-operatively to 37.2° post-operatively. Average grip strength increased from 7.2 kg to 10.2 kg. The QuickDASH, PEM and VAS scores improved in keeping with the reported literature. There were no implant failures. Conclusion We demonstrate similar outcomes for multi-digit Swanson PIPJ arthroplasty compared to the literature for single digit Swanson PIPJ arthroplasty. We conclude that multi-digit arthroplasty in a single operation is safe and effective. Level of Evidence Level IV (Therapeutic).Background Crush injuries of the hand sustained from sugarcane juice extracting machines have a unique mechanism of injury and clinical presentation. The severity of the injury can vary from simple skin lacerations to mangling of the hand. We devised a classification for these injuries based on the severity level that has helped with the management. The aim of this study is to determine whether the classification correlates with patient rated outcome score at 6 months. Methods We prospectively studied 30 consecutive patients with a sugarcane crusher injury of the hand. The patients were classified into Class I, II, III or IV based on our classification and managed accordingly. Patient outcomes were assessed at 6 months after the injury, using the Michigan Hand Outcomes Questionnaire (MHQ). Spearman's rank correlation test was used to analyse the correlation between the different classes of hand injury and functional outcomes at 6 months following injury (measured using MHQ). Results The study included 6 patients (20%) with Class I injury, 11 patients (36.6%) with Class II, 9 patients (30%) with Class III and 4 patients (13.4%) with Class IV injury. The mean MHQ scores at 6-month follow-up were 72.3% in Class I, 62.1% in Class II, 52.9% in Class III and 32% in Class IV injuries. An inversely proportional association between the severity grade as per the classification and MHQ scores was noted. Conclusion Our proposed classification of sugarcane crusher injuries of the hand correlates well with the MHQ score. The use of the classification can help with management and predicting prognosis. In addition, wider use will permit comparison of outcomes between different centres. Level of Evidence Level IV (Therapeutic).Background Management of hand trauma has evolved to incorporate assessment, treatment and rehabilitation of patients in a 'one-stop' clinic on initial presentation. Our aim was to evaluate the effect of coronavirus disease 2019 (COVID-19) on the choice of treatment for hand fractures using inter-rater agreement between surgeons. Methods All patients with hand fractures during the COVID-19 lockdown from March to May 2020 were included in the study. Two experienced hand surgeons blinded to management and outcomes independently reviewed radiographic images and relevant clinical history to provide their opinion on optimal treatment. Weighted kappa analysis was performed to determine concordance and inter-rater agreement between the two surgeons and actual management. Results The study included 82 patients (62 men and 20 women) with a mean age of 40.3 (SD 19.7). The injuries occurred most often at home following an accident (34%) or a fall (28%). Fractures involved the metacarpals in 29 patients and the distal phalanx in 22 patients. Thirty-five patients underwent surgery, whereas 47 were managed conservatively. Overall agreement between actual management and consultant A and consultant B was moderate (κ = 0.55, p less then 0.0001 and κ = 0.63, p less then 0.0001, respectively). Subgroup analysis showed a weak agreement between actual management of metacarpal fractures and consultant A and consultant B (κ = 0.22, p = 0.29 and κ = 0.47, p = 0.02, respectively). Selleckchem PHA-665752 Inter-rater agreement was substantial for management of metacarpal fractures (κ = 0.73, p less then 0.0001), but weak for distal phalanx fractures (κ = 0.29, p = 0.03). Conclusion Our study has shown that overall management of hand fractures remained optimised throughout the pandemic. However, a lack of concordance was observed in the management of metacarpals. Level of Evidence Level IV (Therapeutic).Background Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most widely used patient-reported outcome measure (PROM) for assessment of upper extremity disability assessment. However, DASH is a multidimensional measurement with different difficulty levels and ratio apportionment of the items categorised by ordinal scale. This has caused a misinterpretation of the total disability scores. We created a modified DASH adapted to the Rasch model. The aim of this study is to compare the functional recovery and quality of life (QOL) improvement and to assess the validity of the original DASH and modified DASH between C56/C567, C5-8 and total types of brachial plexus injury (BPI) following surgical reconstruction. Methods A total of 183 BPI patients who underwent reconstructive surgery were evaluated for functional recovery using the range of motion and power of the affected limb, and improvement in QOL with DASH. The collected data were analysed using Rasch measurement theory to detect the misfit items. The original and modified DASH were compared under the three different types of BPI after item reduction by removing the misfit items. Results There were significant differences in functional recovery between three types of palsy. However, PROM using DASH score with or without misfit items (12 items) did not show any significant differences. Conclusions DASH is not suitable for comparison of upper extremity disabilities even after being corrected mathematically due to the inclusion of items from many different domains unequally. Therefore, each item of the function (with or without compensation of the uninjured hand), pain and impact to the patients should be evaluated separately. Level of Evidence Level IV (Prognostic).Background Fracture dislocations of the proximal interphalangeal joint (PIPJ) are challenging injuries and a dynamic external fixator frame is often used. We devised a dynamic external fixator device called the Gexfinger® that allows greater control of the degree of traction. The aim of this study is to report the mid-term outcomes of this device. Methods This is a retrospective study of patients with fracture dislocation of the PIPJ who were treated with the Gexfinger® over a 3-year period. Clinical data with regard to the patient, the injury, treatment and period of follow-up were recorded. The outcome measures included time to return to work, arc of motion at the interphalangeal joints, grip strength, visual analogue score (VAS) for pain, patient satisfaction and complications. Results We studied 26 patients (17 men and 9 women) with an average age of 38 years. The average articular surface involvement was 56%. The mean period between injury and surgery was 6 days and the frames were maintained for 5.5 weeks on average. The mean follow-up period was 8.5 weeks. All patients returned to work at an average of 7 weeks. The mean arc of motion at the PIPJ and distal interphalangeal joint (DIPJ) were 82° and 65°, respectively and the mean grip strength was 83% of the contralateral side. 22 patients reported no pain at the final follow-up. Fifteen patients were very satisfied, 8 satisfied and 3 unsatisfied. Two patients had stiffness of the PIPJ. Conclusions The mid-term outcomes of the Gexfinger® are similar to other methods of dynamic traction described in literature. It is modular, easy to assemble and allows a greater control of the degree of traction. In combination with additional screws and/or K-wires, it has allowed us to treat a wide spectrum of PIPJ fracture dislocations with good outcomes. Level of Evidence Level IV (Therapeutic).Background Syndactyly is one of the commonly encountered congenital hand anomalies. However, there are no strict guidelines regarding the timing of surgical release. The aim of this study was to investigate the age and factors associated with syndactyly release in the United States. Methods A retrospective analysis of the California and Florida State Ambulatory Surgery and Services Databases for patients aged 18 years or younger who underwent syndactyly release surgery between 2005 and 2011 was performed. Demographic data that included the age at release, gender, race and primary payor (insurance) was collected. A sub-analysis was performed to compare the demographic characteristics between those patients undergoing syndactyly release before 5 years of age ('Early Release') and at (of after) 5 years ('Late Release'). Results A total of 2,280 children (68% male, 43% Caucasian) were identified. The mean age of syndactyly release was 3.6 years, and 72.9% of patients underwent release before the age of 5 years. A significantly larger proportion of females (p = 0.
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