Microvascular regeneration in meshed skin transplants after severe burns

Function of the skin lymphatics as well as blood perfusion of a meshed transplant is crucial for the healing. The lymphatic regeneration and arterial perfusion of skin transplants after severe burns of the extremities had been studied in eight patients by microlymphography, laser doppler perfusion imaging and transcutaneous oxygen pressure measurements 1, 6 and 18 months after transplantation. One month after transplantation, only fragmented as well as many giant lymphatic skin vessels were present in the transplant. After 6 months a normal lymphatic network had developed in all grafts. The extension of the dye in the lymphatics decreased from 4.5 (0-16) at 1 month to 3.0 (1-6) mm after 18 months, indicating improved lymph drainage capacity. The permeability of the lymphatics in the graft was normal. After 1 month, median laser flux in the transplant was 155.6% (105-246%) of the normal skin but it normalised within 18 months. By contrast, transcutaneous oxygen measurement (TcPO(2)) increased from 44 (21-47) to 55 (50-76) mmHg. In meshed transplants used to cover severely burned skin morphological and functional normal lymphatics develop within 6 months and the initially increased laser flux due to inflammatory reaction normalises. Our results provide important insights into the healing process of skin transplants after burn

Licofelone, a COX/5-LOX inhibitor blocks chemoattraction of Th1 cells by down regulation of CXCR3 ligands in synovial fibroblasts

No abstract available

Determinants of patient satisfaction after orthopedic interventions to the hand: a review of the literature

Treatment effectiveness is increasingly evaluated from the patients' perspective. However, the interpretation of satisfaction is complex because the patient's perception of a satisfactory outcome is influenced by numerous factors. The objective of this study was to identify which factors are associated with patient satisfaction after orthopedic interventions to the hand. A literature review was conducted, including studies on determinants of satisfaction with treatment outcome or unspecified overall satisfaction of patients with hand problems. The results indicate that patient satisfaction is determined by multiple factors. There is moderate evidence that pain/symptoms, activities of daily living/function, aesthetics, and embodiment influence patient satisfaction. Furthermore, data indicate a correlation of strength, range of motion, fulfillment of expectations, deformity, workers' compensation, and length of follow-up with satisfaction. Knowledge about these determinants may lead to a more detailed decision-making process, thus contributing to improved treatment outcomes and cost-effectiveness. LEVEL OF EVIDENCE: V.Pathophysiology and treatment of rheumatic disease

Licofelone, a COX/5-LOX inhibitor blocks chemoattraction of Th1 cells by down regulation of CXCR3 ligands in synovial fibroblasts

No abstract available

Development of a predictive model for estimating the probability of treatment success one year after total shoulder replacement – cohort study

SummaryObjectiveTo Estimate the probability of treatment success 1 year after a total shoulder arthroplasty by developing a model based on preoperative clinical factors.MethodBetween June 2003 and December 2006, 140 patients undergoing shoulder operations were assessed for age, gender, current rheumatoid arthritis, Short Form (SF) 36 physical and mental sum scores, previous shoulder operations, the Disabilities of Arm, Shoulder and Hand (DASH) symptom and function scores, the Shoulder Pain and Disability Index (SPADI), and insurance status. One year after the operation a Constant score of 80 or more out of 100 indicated successful treatment. Patient variables were analyzed with a logistic regression model augmented in a stepwise manner and bootstrapped 100 times. Variables selected at least 33 times were incorporated into a final model and the Area under the Receiver Operating Characteristics Curve (aROC) was calculated.ResultsThere were 47/140 (33.6%) successful treatments. The probability of success was reduced in patients with previous shoulder operations (Odds Ratio [O.R.] 0.17, 95% Confidence Interval (95%CI) 0.04–0.85; P=0.03) and older than 75 years (O.R. 0.21, 95%CI 0.05–0.77; P=0.02). The probability of success increased in patients with a higher SF 36 mental sum score (O.R. 1.03, 95%CI 0.96–1.09, P=0.42) and a higher DASH function score (O.R. 1.05, 95%CI 1.02–1.07, P=0.001). The aROC was 0.79 (0.70–0.88) indicating that the model has a high predictive capacity.ConclusionOnce validated this model based on four preoperative clinical factors offers a prediction of whether a patient will respond to treatment 1 year after total shoulder arthroplasty