Comparative study of plating versus conservative treatment in mid shaft fractures of clavicle

<p><strong>Background</strong>: Clavicle fractures represent up to 4% and 1% of all fractures, respectively. Historically, both fracture types have been treated conservatively with acceptable outcomes. The surgical correction of these fractures is currently being investigated as a viable alternative to conservative management.</p><p><strong>Methods</strong>: A systematic search of PubMed was performed to identify articles comparing open reduction and internal fixation (ORIF) with conservative treatment for clavicular fractures. Specific outcomes of interest were shoulder function, pain, strength, range of motion, and risk of non-union. </p><p><strong>Results</strong>: ORIF of midshaft clavicular fractures results in increased shoulder function within 6 weeks following treatment and a decreased risk of non-union. After 1 year, there was no longer a difference in shoulder function between groups. There was no difference in pain between treatment groups. Both ORIF and conservative treatment of extraarticular scapular fractures yield comparable results in shoulder function, range of motion, and strength following treatment.</p><p><strong>Conclusions</strong>: This study, early primary plate fixation of comminuted mid shaft clavicular fractures results in improved patient-oriented outcomes, improved surgeon-oriented outcomes, earlier return to function and decreased rates of non-union and malunion. </p>

Development and Validation of a Shortened Form of SELweb EE, a Web-Based Assessment of Children’s Social and Emotional Competence

This article describes the development and validation of a shortened form of SELweb EE, a web-based assessment for social–emotional skills in the early elementary grades. Using a Rasch approach, in the first study, we used data from two archival data sets to reduce the number of items in three subtests to create short forms that maintained item fit, item difficulty, item discrimination, and test information function range. In the second study, we created and administered a short form of SELweb EE to a demographically diverse cross-validation sample of 22,683 students. We evaluated the shortened assessment subtests’ score reliability, fit to a hypothesized factor structure, and association with age and other variables to evaluate criterion-related validity. Findings from this study suggest that score reliabilities, factor structure, and criterion-related validity for the short form are similar to corresponding properties of the long form. In addition, using a confirmatory factor analysis framework, the short form of SELweb EE demonstrated evidence of configural, metric, and scalar invariance across sex, ethnicity, and language. Shortening SELweb EE reduced the mean administration duration from 36 to 24 minutes. This reduction substantially increases its usability and feasibility while maintaining its psychometric merit.

Effect of physical activity levels on oncological breast surgery recovery: a prospective cohort study

After breast cancer (BC) surgery, women may experience a physical decline. The effect of physical activity (PA) on the course of recovery after BC surgery has not yet been thoroughly examined. To analyze the impact of physical activity performed by women undergoing breast cancer surgery on measures of function, range of motion, and self-efficacy. A prospective study was carried out in 157 patients who underwent surgery for BC between October 2018 and April 2019, divided into four groups according to the intensity of PA with 6 months follow-up. 50 sedentary patients and 107 active patients were enrolled; the mean age was 52.6. Women who performed physical activity, moderate to vigorous, demonstrated lower function disabilities (QuickDASH 2.22) compared with inactivity or light physical activity (QuickDASH 7.0, p < 0.001), with better shoulder flexion (159.0° vs. 150.7°, p = 0.007) and abduction (159.5° vs. 152.2°, p = 0.008). Higher PA levels, displayed in higher self-efficacy reports (9.5 vs. 8.8, p = 0.002), and return to prior job status (0.005). The PA level does not influence pain at one, three and 6 months postoperatively (p = 0.278, p = 0.304 and p = 0.304 respectively). High PA levels increase the risk of axillary web syndrome (p = 0.041), although, it reduces the incidence of chronic pain (p = 0.007). Women who practice physical activity recover better from BC surgery than sedentary women. The higher the intensity and frequency of training, the better the results. Vigorous activity cause axillary web syndrome, despite, it has a beneficial effect on lowering the rate of chronic pain.

An optimization problem for continuous submodular functions

"Real continuous submodular functions, as a generalization of the corresponding discrete notion to the continuous domain, gained considerable attention recently. The analog notion for entropy functions requires additional properties: a real function defined on the non-negative orthant of $\R^n$ is entropy-like (EL) if it is submodular, takes zero at zero, non-decreasing, and has the Diminishing Returns property. Motivated by problems concerning the Shannon complexity of multipartite secret sharing, a special case of the following general optimization problem is considered: find the minimal cost of those EL functions which satisfy certain constraints. In our special case the cost of an EL function is the maximal value of the $n$ partial derivatives at zero. Another possibility could be the supremum of the function range. The constraints are specified by a smooth bounded surface $S$ cutting off a downward closed subset. An EL function is feasible if at the internal points of $S$ the left and right partial derivatives of the function differ by at least one. A general lower bound for the minimal cost is given in terms of the normals of the surface $S$. The bound is tight when $S$ is linear. In the two-dimensional case the same bound is tight for convex or concave $S$. It is shown that the optimal EL function is not necessarily unique. The paper concludes with several open problems."

On boundedness of the Hilbert transform on Marcinkiewicz spaces

We study boundedness properties of the classical (singular) Hilbert transform (Hf)(t) = p.v.1/π \int_R f(s)/(t − s)ds acting on Marcinkiewicz spaces. The Hilbert transform is a linear operator which arises from the study of boundary values of the real and imaginary parts of analytic functions. Questions involving the H arise therefore from the utilization of complex methods in Fourier analysis, for example. In particular, the H plays the crucial role in questions of norm-convergence of Fourier series and Fourier integrals. We consider the problem of what is the least rearrangement-invariant Banach function space F(R) such that H : Mφ(R) → F(R) is bounded for a fixed Marcinkiewicz space Mφ(R). We also show the existence of optimal rearrangement-invariant Banach function range on Marcinkiewicz spaces. We shall be referring to the space F(R) as the optimal range space for the operator H restricted to the domain Mφ(R) ⊆ Λϕ0(R). Similar constructions have been studied by J.Soria and P.Tradacete for the Hardy and Hardy type operators [1]. We use their ideas to obtain analogues of their some results for the H on Marcinkiewicz spaces.

The effect of an eight-week shoulder rehabilitation intervention programme on pain and function, range of motion and muscle strength among teachers: A pilot study

BACKGROUND: Teachers present with shoulder musculoskeletal disorders, which result in pain and poor shoulder function. OBJECTIVE: To determine the effect of an eight-week shoulder rehabilitation intervention on pain and function, range of motion and muscle strength among teachers. METHODS: Thirty teachers presenting with shoulder pain were recruited and divided into equal control and experimental groups. The intervention group participated in an eight-week rehabilitation programme. Pre- and post-intervention measurements included the scapular position test, range of motion, muscle strength measurements as well as a shoulder rating questionnaire. RESULTS: There was a significant improvement in the experimental group’s internal range of motion for the dominant (p= 0.006) and non-dominant arms (p= 0.003) post-intervention. Additionally, significant improvements were found in muscle strength in the experimental group in dominant and non-dominant flexion; abduction; external rotation (p< 0.001); dominant internal rotation (p< 0.001) and non-dominant internal rotation strength (p= 0.007). Post-intervention questionnaire data found a decrease in pain (p= 0.003); improved ability to perform daily activities (p= 0.006); improved overall score (p< 0.001) and satisfaction (p= 0.023) in the intervention group compared to the control group. CONCLUSION: The implementation of a rehabilitation programme in schools should be considered to manage the prevalence of shoulder musculoskeletal disorders among teachers.

P0339URINE METABOLOMIC ASSAY IN EARLY IGA NEPHROPATHY PATIENTS REVEALS URINE GLYCINE AS A PROGNOSTIC BIOMARKER

Background and Aims A urine metabolomic biomarker from early immunoglobulin A nephropathy (IgAN) can be a useful tool for early detection or prognostic prediction of the disease. Method We profiled the urine metabolomes, using nuclear magnetic resonance (NMR) spectrometry, from 197 IgAN patients with eGFR ≥ 60 mL/min/1.73 m2, and the patients with same kidney function range but have diagnosis of membranous nephropathy (n=81) and minimal change disease (n=50) were included as the disease-control group. Additional 146 healthy controls who received routine health screenings and donated urine samples were included. We calculated the creatinine-adjusted urine concentrations of 27 urine metabolites. Urine metabolites specifically increased in urines from IgAN patients were identified, and their associations with the prognosis of the disease, determined with the outcome of eGFR 30% reduction from baseline, were investigated. Additional kidney biopsy samples from independent patients and controls were stained for molecules included in related biological process for experimental validation. Results Among the 15 metabolites higher in the urines from IgAN patients than those from the healthy controls, only glycine was the metabolite that the median level was significantly higher also than that of the disease-control group. We found that the higher levels of glycine, alanine, citrate, threonine, and valine were significantly associated with higher risks of 30% eGFR reduction in IgAN patients. Among the molecules related to metabolism of glycine, expressions of T and H proteins from glycine cleavage system were significantly reduced in the kidney biopsy slides from independent IgAN patients when compared to the controls. Conclusion Urine glycine may be a prognostic and pathophysiology-related biomarker of IgAN. A further study confirming the clinical usefulness and pathophysiologic significance of urine metabolites in IgAN patients is warranted.

Motion-preserving treatment of unstable atlas fracture: transoral anterior C1-ring osteosynthesis using a laminoplasty plate

Background C1-ring osteosynthesis is a valid alternative to posterior C1–C2 or C0–C2 fusion to preserve important C1–C2 motion in the treatment of unstable atlas fractures. Nevertheless, the fixation instruments used in current studies for transoral anterior C1-ring osteosynthesis were not suitable for anterior anatomy of the atlas or did not have reduction mechanism. We therefore present this report to investigate preliminary clinical effects of transoral anterior C1-ring osteosynthesis using a laminoplasty plate in unstable atlas fractures. Methods From January 2014 to December 2017, 13 patients with unstable atlas fractures were retrospectively reviewed. All patients were treated with transoral anterior C1-ring osteosynthesis using a laminoplasty plate. Pre- and postoperative images were obtained to assess reduction of the fracture, internal fixation placement, and bone union. Neurological function, range of motion, and pain levels were evaluated clinically on follow-up. Results The surgeries were successfully performed in all cases. The average follow-up duration was 16.6 ± 4.4 months (range 12–24 months). One patient suffered screw loosening after operation and underwent replacement operation subsequently. Satisfactory clinical outcomes were achieved in all patients with ideal fracture reduction, reliable plate placement, well-preserved range of motion, and neck pain alleviation. All patients achieved bone union of fractures without loss of reduction or implant failure or C1–C2 instability during the follow-up. No vascular or neurological complication was noted during the operation and follow-up. Conclusions Transoral anterior C1-ring osteosynthesis using a laminoplasty plate is a effective surgical treatment for unstable atlas fractures. This technique has a ingenious reduction mechanism, and can provide satisfactory bone union and preservation of C1–C2 motion.

Connexins: Key Players in the Control of Vascular Plasticity and Function

Of the 21 members of the connexin family, 4 (Cx37, Cx40, Cx43, and Cx45) are expressed in the endothelium and/or smooth muscle of intact blood vessels to a variable and dynamically regulated degree. Full-length connexins oligomerize and form channel structures connecting the cytosol of adjacent cells (gap junctions) or the cytosol with the extracellular space (hemichannels). The different connexins vary mainly with regard to length and sequence of their cytosolic COOH-terminal tails. These COOH-terminal parts, which in the case of Cx43 are also translated as independent short isoforms, are involved in various cellular signaling cascades and regulate cell functions. This review focuses on channel-dependent and -independent effects of connexins in vascular cells. Channels play an essential role in coordinating and synchronizing endothelial and smooth muscle activity and in their interplay, in the control of vasomotor actions of blood vessels including endothelial cell reactivity to agonist stimulation, nitric oxide-dependent dilation, and endothelial-derived hyperpolarizing factor-type responses. Further channel-dependent and -independent roles of connexins in blood vessel function range from basic processes of vascular remodeling and angiogenesis to vascular permeability and interactions with leukocytes with the vessel wall. Together, these connexin functions constitute an often underestimated basis for the enormous plasticity of vascular morphology and function enabling the required dynamic adaptation of the vascular system to varying tissue demands.