Modified minimally invasive extensor carpi radialis longus tenodesis for scapholunate dissociation:A prospective observational study

Background: Scapholunate dissociation is the most common form of carpal instability. However, there is no gold standard for operative treatment. In this prospective observational study on 54 patients, a modified minimally invasive dynamic extensor carpi radialis longus tenodesis is described, which is characterized by a smaller approach and application of a cannulated screw and washer for tendon fixation.Methods: Quick-Disabilities of Arm, Shoulder and Hand (DASH)-questionnaire results, post-operative satisfaction, range of motion and grip strength are analyzed.Results: A median Quick-DASH of 54.6 was observed pre-operatively which significantly improved to a median of 28.4 after the procedure (p &lt;0.001). Median follow-up was 24 months. Of 46 completely followed-up patients, 31 patients (67.4%) reported that they were satisfied with the outcome. Thirty-seven patients (80.4%) would recommend the procedure to a friend. Thirty-five patients (76.1%) reported some kind of complaint in the operated hand during follow-up. There was no association of severity of symptoms and co-morbidities with the outcome. Neither palmar flexion, nor dorsal extension was significantly different between the operated and non-operated wrist. The operated wrists were observed to have less grip strength than non-operated wrists.Conclusions: The presented method seems to be as successful as other techniques described in literature. It is less invasive, thus more patient friendly without harming feasibility of future salvage options. However, post-operative complaint rate was quite high.</p

Halted-Pendulum Relaxation: Application to White Dwarf Binary Initial Data

Studying compact star binaries and their mergers is integral to modern astrophysics. In particular, binary white dwarfs are associated with Type Ia supernovae, used as standard candles to measure the expansion of the Universe. Today, compact-star mergers are typically studied via state-of-the-art computational fluid dynamics codes. One such numerical techniques, Smoothed Particle Hydrodynamics (SPH), is frequently chosen for its excellent mass, energy, and momentum conservation. Furthermore, the natural treatment of vacuum and the ability to represent highly irregular morphologies make SPH an excellent tool for the numerical study of compact-star binaries and mergers. However, for many scenarios, including binary systems, the outcome simulations are only as accurate as the initial conditions. For SPH, it is essential to ensure that particles are distributed semi-regularly, correctly representing the initial density profile. Additionally, particle noise in the form of high-frequency local motion and low-frequency global dynamics must be damped out. Damping the latter can be as computationally intensive as the actual simulation. Here, we discuss a new and straightforward relaxation method, Halted-Pendulum Relaxation (HPR), to remove the global oscillation modes of SPH particle configurations. In combination with effective external potentials representing gravitational and orbital forces, we show that HPR has an excellent performance in efficiently relaxing SPH particles to the desired density distribution and removing global oscillation modes. We compare the method to frequently used relaxation approaches such as gravitational glass, increased artificial viscosity, and Weighted Voronoi Tesselations, and test it on a white dwarf binary model at its Roche lobe overflow limit

Prospective Evaluation of Low-Dose External Beam Radiotherapy (LD-EBRT) for Painful Trapeziometacarpal Osteoarthritis (Rhizarthrosis) on Pain, Function, and Quality of Life to Calculate the Required Number of Patients for a Prospective Randomized Study

Background: Retrospective studies have described the effectiveness of low-dose radiotherapy (LD-EBRT) in painful arthrosis of small finger joints, but two recent prospective studies have yielded ambiguous results. To generate accurate data for the planning of a trial, we conducted a prospective, monocentric, observational study to describe the effects of LD-EBRT as precisely as possible. Methods: Twenty-five consecutive patients with symptomatic trapeziometacarpal (TMC) arthrosis were irradiated with 6 × 0.5 Gy. Before, 3, and 12 months after LD-EBRT, we assessed subjective endpoints (modified “von-Pannewitz score”, 10-point visual analogue scale (VAS), “patient-rated wrist evaluation” (PRWE)), and objective measurements (“active range of motion” (AROM), Kapandji index, grip strength, pinch grip). Results: At 3/12 months, 80%/57% reported partial and 4%/18% complete remission according to the “von-Pannewitz” score. VAS “overall pain” significantly decreased from a median of seven (IQR 4) at baseline to three (IQR 6; p = 0.046) and to two (IQR 2; p = 0.013). Similar results were obtained for VAS “pain during exercise”, VAS “pain during daytime”, and VAS “function”. “PRWE overall score” was reduced from 0.5 at baseline (SD 0.19) to 0.36 (SD 0.24, p = 0.05) and to 0.27 (SD 0.18, p = 0.0009). We found no improvements of the objective endpoints (AROM, Kapandji, grip strength) except for flexion, which increased from 64° (SD 12°) at baseline to 73° (SD 9.7°, p = 0.046) at 12 months. Conclusions: We recommend the PRWE score as a useful endpoint for further studies for this indication. To prove a 15% superiority over sham irradiation, we calculated that 750 patients need to be prospectively randomized

Comparable outcome of liver transplantation with Histidine-Tryptophan-Ketoglutarate vs. University of Wisconsin preservation solution: a retrospective observational double-center trial

I studien har 12 elevgrupper från 10 kommunala skolor i Malmö studerats statistiskt frånläsåren 2005/06 till 2013/14. Utifrån elevernas socioekonomiska bakgrund undersöktes effekten av skolornas resursutbud för PISA-resultaten i årskurs 9. Genom teorier om skolan som arena för social reproduktion av medelklassens värden, visade analysen att skolan inte uppväger för arbetarklasselever utan eftergymnasialt utbildade föräldrar. Slutsatserna visade att observationsgruppernas höga lärarbehörighet kombinerat med ökad lärartäthet för utsatta elevgrupper, inte ensamt utjämnar bakgrundsrelaterad skolsegregation. Som insatskomplement bör skolornas elevsammansättning ses som en administrativt förändringsbar resurs, jämte utökat arbete för bredare konsensus mellan hem och skola kring utbildningens betydelse och form.This study carries out a Qualitative Comparative Analysis [QCA] of 12 groups of studentsfrom 10 public schools in Malmoe. Based on students’ socioeconomic background, the study examines the effect of school resources across 9 years of elementary school; on PISA results in grade 9. Using the theoretical framework that school is an institution to promote social reproduction of middle-class values; the analysis demonstrates that school does not compensate working class students. The study's conclusions where that the observation groups generally high teaching qualifications; combined with increased teacher ratio for vulnerable student groups, not alone were sufficient resources to equalize background related school segregation. These need to be complemented with a broader consensus between home and school about the importance of education and its execution. Also the school pupil homogeneous composition should thereto be seen as an administrative opportunity to level the playing field in the present segregated school situation

Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss

Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/&gt;1h, ≤2h/&gt;2h, ≤3h/&gt;3h, . . ., ≤nh/&gt;nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best 2 was identified. First and second derivative were then implemented into the curvature formula ( ) = ( )/(1 + ( ) 2 ) 3/2 to determine the point of highest CIT-mediated risk acceleration. Results. Surgery between 3 AM and 6 AM is an independent risk factor for reoperation and graft loss, whereas prolonged CIT is only relevant for DGF. CIT-mediated risk for DGF follows an exponential pattern ( ) = ⋅ (1 + ⋅ ( ⋅ ) ) with a cut-off for the highest risk increment at 23.5 hours. Conclusions. The risk of surgery at 3 AM-6 AM outweighs prolonged CIT when confined within 23.5 hours as determined by a new mathematical approach to calculate turning points of nonlinear time related risks. CIT is only relevant for the endpoint of DGF but had no impact on discharge on dialysis, reoperation, or graft loss

Prognostic Abilities and Quality Assessment of Models for the Prediction of 90-Day Mortality in Liver Transplant Waiting List Patients.

Model of end-stage liver disease (MELD)-score and diverse variants are widely used for prognosis on liver transplant waiting-lists.818 consecutive patients on the liver transplant waiting-list included to calculate the MELD, MESO Index, MELD-Na, UKELD, iMELD, refitMELD, refitMELD-Na, upMELD and PELD-scores. Prognostic abilities for 90-day mortality were investigated applying Receiver-operating-characteristic-curve analysis. Independent risk factors for 90-day mortality were identified with multivariable binary logistic regression modelling. Methodological quality of the underlying development studies was assessed with a systematic assessment tool.74 patients (9%) died on the liver transplant waiting list within 90 days after listing. All but one scores, refitMELD-Na, had acceptable prognostic performance with areas under the ROC-curves (AUROCs)>0.700. The iMELD performed best (AUROC = 0.798). In pediatric cases, the PELD-score just failed to reach the acceptable threshold with an AUROC = 0.699. All scores reached a mean quality score of 72.3%. Highest quality scores could be achieved by the UKELD and PELD-scores. Studies specifically lack statistical validity and model evaluation.Inferior quality assessment of prognostic models does not necessarily imply inferior prognostic abilities. The iMELD might be a more reliable tool representing urgency of transplantation than the MELD-score. PELD-score is assumedly not accurate enough to allow graft allocation decision in pediatric liver transplantation