Evaluation and Management of Sleep Disorders in the Hand Surgery Patient.

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition

Online Community Learning: Why Does (Language) Learning Without Classroom Interest Students of All Disciplines? a Case Study

This case study explores the language learners' growing interest to express their shared interest in online-course-providing platforms. This study also inquires into the language learners' new forum called “online community” and its great influence on smart way teaching-learning process and classroom dynamics, technology enabled lifelong self study mode of learning, subject knowledge, learning centred curriculum, experience centred approach to the learning process, course material and soft/life skills delivered along the course as a value added package. This paper examines the way MOOCs have opened the gate way of learning to all sections of society free of cost with specific language skills focus – writing that interests students from all disciplines. This study suggests that the rising generation shows a growing, academic interest in online collaboration on the basis of any subject specific shared interest and this collective interest also addresses the concern about personal experiences with emotive foundation that will not have space in online teaching learning process

Predicting Revision Following In Situ Ulnar Nerve Decompression for Patients With Idiopathic Cubital Tunnel Syndrome.

PURPOSE: To determine the incidence of revision and potential risk factors for needing revision surgery following in situ ulnar nerve decompression for patients with idiopathic cubital tunnel syndrome (CTS). METHODS: We conducted a retrospective chart review of all patients treated at 1 specialty hand center with an open in situ ulnar nerve decompression for idiopathic CTS from January 2006 through December 2010. Revision incidence was determined by identifying patients who underwent additional surgeries for recurrent or persistent ulnar nerve symptoms. Bivariate analysis was performed to determine which variables had a significant influence on the need for revision surgery. RESULTS: Revision surgery was required in 3.2% (7 of 216) of all cases. Age younger than 50 years at the time of index decompression was the lone significant predictor of need for revision surgery. Other patient factors, including gender, diabetes, smoking history, and workers\u27 compensation status were not predictive of the need for revision surgery. Disease-specific variables including nerve conduction velocities, McGowan grading, and predominant symptom type were also not predictive of revision. CONCLUSIONS: For patients with idiopathic CTS, the risk of revision surgery following in situ ulnar nerve decompression is low. However, this risk was increased in patients who were younger than 50 years at the time of the index procedure. The findings of this study suggest that, in the absence of underlying elbow arthritis or prior elbow trauma, in situ ulnar nerve decompression is an effective, minimal-risk option for the initial surgical treatment of CTS. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III

Non-invasive hemodynamic evaluation by Doppler echocardiography

The approach for treating a hemodynamically unstable patient remains a diagnostic and therapeutic challenge. Stabilization of the patient should be rapid and effective, but there is not much room for error. This narrow window of intervention makes it necessary to use rapid and accurate hemodynamic evaluation methods. Echocardiography is the method of choice for the bedside evaluation of patients in circulatory shock. In fact, it was intensive care physicians who recognized the potential of Doppler echocardiography for the initial approach to patients in circulatory failure. An echocardiogram allows rapid anatomical and functional cardiac evaluation, which may include non-invasive hemodynamic evaluation using a Doppler study. Such an integrated study may provide data of extreme importance for understanding the mechanisms underlying the hemodynamic instability of the patient to allow the rapid institution of appropriate therapeutic measures. In the present article, we describe the most relevant echocardiographic findings using a practical approach for critical patients with hemodynamic instability.info:eu-repo/semantics/publishedVersio

Assessment of an hybrid multi-objective pattern search filter method

A hybrid multi-objective evolutionary algorithm (MOEA) for solving nonlinear multi-objective opti- mization problems that relies on a pattern search filter method is proposed. The aim is to reduce the computational time involved in solving expensive multi-objective problems by improving a subset of Pareto points. The proposed pattern search filter method relies on two components. Each entry in the filter aims to measure feasibility and optimality. The feasibility and optimality come directly from each single-objective nonlinear program problem that is associated to the multi-objective problem. Experi- ments carried out with a set of nonlinear multi-objective problems show that our pattern search filter approach is effective in reaching improved Pareto points. A comparison with other techniques known in the literature is presented.Fundação para a Ciência e a Tecnologia - Pluriannual Funding Program

Study of solids conveying in single screw extruders based on flow dynamics and structure of solid pellets

Flow of granular matter is presently a subject of extensive research, due to the characteristics of this type of systems (e.g., dilatancy, segregation, arching, clustering) and relevance to various application areas, such as civil construction, agriculture, food processing, geophysics, pharmacology [1, 2]. The plasticating process in single screw polymer extrusion is one of the areas where this research can help to increase the existing knowledge. In the initial turns of an Archimedes-type screw, loose pellets are conveyed forward. However, traditional analyses assume the movement of an elastic solid plug at constant velocity. This work follows previous efforts to predict the characteristics of this flow using the Discrete Element Method (DEM) [3, 4]. Two boundary conditions are considered: a) open-discharge, implying that no compaction of the solids occurs and b) close-discharge, leading to a pressure increase. The dynamics and the structure of the flow were studied by computing the cross- and down channel velocity profiles, the coordination number distribution, the output rate, the residence time distribution and the density profile, as a function of the friction force grain-wall, screw speed and pellet size. The model is able to capture the process of plug formation towards the discharge, and its predictions provide an insight into possible flow fluctuations

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques.

Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results: At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; P \u3c .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; P \u3c .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; P \u3c .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P \u3c .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion: A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm

C3 Deficiency – A Case Report

O sistema do complemento é um componente essencial do sistema imunitário inato, pelo que as deficiências de proteínas da sua complexa cascata podem ter consequências mais ou menos graves, de acordo com a importância do factor afectado. As complicações mais usuais das deficiências do complemento são infecções recorrentes a bactérias encapsuladas e distúrbios autoimunes. Os autores apresentam um caso clínico de deficiência do factor C3, situação extremamente rara, discutindo a fisiopatologia, apresentação clínica, investigação laboratorial e abordagem terapêutica