Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty

INTRODUCTION Iatrogenic nerve injury in orthopedic surgery can impair functional outcomes. During the last years, a steady increase in the number of performed reverse total shoulder arthroplasties has been reported and complications associated with this procedure are continuously described. Neurological complications, however, remain underreported. The aims of this study were to calculate the incidence of iatrogenic nerve injury after primary and revision reverse total shoulder arthroplasty in a large patient cohort, as well as identify associated patient-and surgery-related risk factors. MATERIALS AND METHODS A retrospective review of our institution's internal Reverse Total Shoulder Arthroplasty (RTSA) database from September 2005 to December 2019 was undertaken and 34 patients with iatrogenic nerve injuries were identified, resulting in a neurological complication rate of 2.6%. Group comparisons between patients with nerve injuries (n = 34) and the remaining cohort without nerve injuries (n = 1275) were performed to identify patient- and surgery-related risk factors. RESULTS Of the 34 cases with iatrogenic nerve injury, damage to terminal nerve branches occurred in 21 patients, whereas a brachial plexus lesion was diagnosed in the other 13. Nerve revision surgery was necessary in four patients. At final follow-up 13 patients (45%) had residual motor deficits and 17 (59%) had residual sensory deficits. Higher numbers of previous surgeries of the affected shoulder correlated with subsequent nerve injury (p = 0.035). Operative time was significantly longer in patients, who developed a neurologic deficit, showing a correlation between duration of surgery and occurrence of nerve injury (p = 0.013). Patients with neurologic complications were significantly younger than patients without nerve damage (median 68 vs. 72 years, p = 0.017). CONCLUSIONS In specialists' hands reverse total shoulder arthroplasty is a rather safe procedure regarding the risk of neurologic injury. However, multiple previous surgeries of the affected shoulder increase the risk of neurological complications. Cases with post-operative neurologic compromise are rare and usually recover well, with few patients suffering long-term functional deficits from iatrogenic nerve injury. LEVEL OF EVIDENCE Level III, retrospective cohort study

The Balanced Scorecard (BSC) as a Multidimensional Performance Measurement System Tool: Case the Company of Algeria Post

This paper aimed to clarify the role that the Balanced Scorecard (BSC) as a performance measurement tool in the company of Algeria Post. The BSC is a strategic performance management system, has been proven suitable for the public sector as the financial aspect is not their only concern. The BSC is « A multidimensional performance measurement system that should serve as decision support for managers. It includes indicators of progress and delay as well as internal and external indicators. It organizes the measures in a coherent system around four balanced perspectives: financial perspective, customer perspective, internal process, learning, and growth ». (Kaplan. S & Norton, 2004, P186)

Anti-angiogenic effects of pterogynidine alkaloid isolated from Alchornea glandulosa

<p>Abstract</p> <p>Background</p> <p>Angiogenesis, a complex multistep process that comprehends proliferation, migration and anastomosis of endothelial cells (EC), has a major role in the development of pathologic conditions such as inflammatory diseases, tumor growth and metastasis. Brazilian flora, the most diverse in the world, is an interesting spot to prospect for new chemical leads, being an important source of new anticancer drugs. Plant-derived alkaloids have traditionally been of interest due to their pronounced physiological activities. We investigated the anti-angiogenic potential of the naturally occurring guanidine alkaloid pterogynidine (Pt) isolated from the Brazilian plant <it>Alchornea glandulosa</it>. The purpose of this study was to examine which features of the angiogenic process could be disturbed by Pt.</p> <p>Methods</p> <p>Human umbilical vein endothelial cells (HUVEC) were incubated with 8 μM Pt and cell viability, proliferation, apoptosis, invasion and capillary-like structures formation were addressed. Nuclear factor κB (NFκB), a transcription factor implicated in these processes, was also evaluated in HUVEC incubated with Pt. Quantifications were expressed as mean ± SD of five independent experiments and one-way analysis of variance (ANOVA) followed by the Dunnet test was used.</p> <p>Results</p> <p>A significant decrease in proliferation and invasion capacity and an effective increase in apoptosis as assessed by bromodeoxyuridine (BrdU), double-chamber and terminal transferase dUTP nick end labeling (TUNEL) assay, respectively, have been found. Pt also led to a drastic reduction in the number of capillary-like structures formation when HUVEC were cultured on growth factor reduced-Matrigel (GFR-Matrigel) coated plates. In addition, incubation of HUVEC with Pt resulted in reduced NFκB activity.</p> <p>Conclusion</p> <p>These findings emphasize the potential use of Pt against pathological situations where angiogenesis is stimulated as tumor development.</p

Knorpelreparative Eingriffe am Schultergelenk

Asymptomatic cartilage lesions of the shoulder are frequent. Symptomatic lesions are treated analogously to other hyaline cartilage bearing joints and can be treated arthroscopically in the vast majority of cases. The therapeutic options can be subdivided into resection, stimulation and transplantation of the defect cartilage. There are only a few reports about outcome after cartilage restoration surgery in the literature, and microfracturing is the surgical technique that has been most investigated

Results after delayed axillary nerve reconstruction with interposition of sural nerve grafts

HYPOTHESIS: Satisfactory results after repair of isolated axillary nerve lesions using sural nerve autografts have been reported, but a delay between injury and surgical repair exceeding 6 months was one of the most important negative predictors of functional outcome. From our experience, we hypothesize that good results can be obtained even after a delay exceeding 6 months and we opted in this study to assess the value of delayed axillary nerve reconstruction. MATERIALS AND METHODS: We evaluated clinical outcome and donor-site morbidity in 12 patients (mean age, 37; range, 19-66 years) who underwent axillary nerve repair with sural nerve graft with an average 11.25-month a delay between trauma and surgery (range, 8-20 months). Follow-up examination at least 24 months after treatment included assessment of shoulder range of motion, deltoid muscle strength in near full extension, deltoid extension lag, and sensibility. Constant Score, subjective shoulder value, and the Disabilities of Arm, Shoulder and Hand score were also assessed. RESULTS: All patients showed an improved deltoid function of at least M3. Postoperative extension lag, as the most specific sign of isolated deltoid function, improved from 57.5 degrees to 14.2 degrees. All stated that they would have identical elective surgery again. Relevant donor-site morbidity was not observed. CONCLUSION: Our data indicate that even delayed axillary nerve grafting may lead to satisfactory functional results with a low morbidity and should therefore be done in selected patients. 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved

High-resolution Med-CORDEX regional climate model simulations for hydrological impact studies : a first evaluation of the ALADIN-Climate model in Morocco

In the framework of the international CORDEX program, new regional climate model (RCM) simulations at high spatial resolutions are becoming available for the Mediterranean region (Med-CORDEX initiative). This study provides the first evaluation for hydrological impact studies of one of these high-resolution simulations in a 1800 km(2) catchment located in North Morocco. Different approaches are compared to analyze the climate change impacts on the hydrology of this catchment using a high-resolution RCM (ALADIN-Climate) from the Med-CORDEX initiative at two different spatial resolutions (50 and 12 km) and for two different Radiative Concentration Pathway scenarios (RCP4.5 and RCP8.5). The main issues addressed in the present study are: (i) what is the impact of increased RCM resolution on present-climate hydrological simulations and on future projections? (ii) Are the bias-correction of the RCM model and the parameters of the hydrological model stationary and transferable to different climatic conditions? (iii) What is the climate and hydrological change signal based on the new Radiative Concentration Pathways scenarios (RCP4.5 and RCP8.5)? Results indicate that high resolution simulations at 12 km better reproduce the seasonal patterns, the seasonal distributions and the extreme events of precipitation. The parameters of the hydrological model, calibrated to reproduce runoff at the monthly time step over the 1984-2010 period, do not show a strong variability between dry and wet calibration periods in a differential split-sample test. However the bias correction of precipitation by quantile-matching does not give satisfactory results in validation using the same differential split-sample testing method. Therefore a quantile-perturbation method that does not rely on any stationarity assumption and produces ensembles of perturbed series of precipitation was introduced. The climate change signal under scenarios 4.5 and 8.5 indicates a decrease of respectively -30 to -57% in surface runoff for the mid-term (2041-2062), when for the same period the projections for precipitation are ranging between -15 and -19% and for temperature between + 1.3 and + 1.9 degrees C

High-resolution Med-CORDEX regional climate model simulations for hydrological impact studies: a first evaluation of the ALADIN-Climate model in Morocco

International audienceIn the framework of the international CORDEX program, new regional climate model (RCM) simulations at high spatial resolutions are becoming available for the Mediterranean region (Med-CORDEX initiative). This study provides the first evaluation for hydrological impact studies of one of these high-resolution simulations in a 1800 km(2) catchment located in North Morocco. Different approaches are compared to analyze the climate change impacts on the hydrology of this catchment using a high-resolution RCM (ALADIN-Climate) from the Med-CORDEX initiative at two different spatial resolutions (50 and 12 km) and for two different Radiative Concentration Pathway scenarios (RCP4.5 and RCP8.5). The main issues addressed in the present study are: (i) what is the impact of increased RCM resolution on present-climate hydrological simulations and on future projections? (ii) Are the bias-correction of the RCM model and the parameters of the hydrological model stationary and transferable to different climatic conditions? (iii) What is the climate and hydrological change signal based on the new Radiative Concentration Pathways scenarios (RCP4.5 and RCP8.5)? Results indicate that high resolution simulations at 12 km better reproduce the seasonal patterns, the seasonal distributions and the extreme events of precipitation. The parameters of the hydrological model, calibrated to reproduce runoff at the monthly time step over the 1984-2010 period, do not show a strong variability between dry and wet calibration periods in a differential split-sample test. However the bias correction of precipitation by quantile-matching does not give satisfactory results in validation using the same differential split-sample testing method. Therefore a quantile-perturbation method that does not rely on any stationarity assumption and produces ensembles of perturbed series of precipitation was introduced. The climate change signal under scenarios 4.5 and 8.5 indicates a decrease of respectively -30 to -57% in surface runoff for the mid-term (2041-2062), when for the same period the projections for precipitation are ranging between -15 and -19% and for temperature between + 1.3 and + 1.9 degrees C

Local activation of light-induced degradation in co-doped boron-phosphorus silicon: Evidence of defect diffusion phenomena

International audienceThis study is interested in the local activation of Light-induced degradation (LID) defect in highly co-doped silicon wafers with boron and phosphorus. For this purpose, the experiments are focused on measuring the minority carrier lifetime before and after LID activation via a mapping technique. The LID defect density exhibits a Gaussian distribution centered on the excitation point of the laser beam; the intensity of the Gaussian distribution of the LID defect varies with the concentration of the co-dopants. The lifetime of the minority carriers decreases in all-silicon sample regions, while the excitation laser beam focuses on an area of approximately one mm2. This observation indicates that LID defects are activated even in the unexcited areas of silicon wafers, suggesting a LID diffusion phenomenon from the laser excitation point to the whole silicon wafer. We deduce that a high phosphorus doping level in silicon wafers leads to a significant reduction in the LID effect

The lever arm ratio of the rotator cuff to deltoid muscle explains and predicts pseudoparalysis of the shoulder

AIMS In patients with a rotator cuff tear, tear pattern and tendon involvement are known risk factors for the development of pseudoparalysis of the shoulder. It remains unclear, however, why similar tears often have very different functional consequences. The present study hypothesizes that individual shoulder anatomy, specifically the moment arms (MAs) of the rotator cuff (RC) and the deltoid muscle, as well as their relative recruitment during shoulder abduction, plays a central role in pseudoparalysis. MATERIALS AND METHODS Biomechanical and clinical analyses of the pseudoparalytic shoulder were conducted based on the ratio of the RC/deltoid MAs, which were used to define a novel anatomical descriptor called the Shoulder Abduction Moment (SAM) index. The SAM index is the ratio of the radii of two concentric spheres based on the centre of rotation of the joint. One sphere captures the humeral head (numerator) and the other the deltoid origin of the acromion (denominator). A computational rigid body simulation was used to establish the functional link between the SAM index and a potential predisposition for pseudoparalysis. A retrospective radiological validation study based on these measures was also undertaken using two cohorts with and without pseudoparalysis and massive RC tears. RESULTS Decreased RC activity and improved glenohumeral stability was predicted by simulations of SAM indices with larger diameters of the humeral head, being consequently beneficial for joint stability. Clinical investigation of the SAM index showed significant risk of pseudoparalysis in patients with massive tears and a SAM < 0.77 (odds ratio (OR) 11). CONCLUSION The SAM index, which represents individual biomechanical characteristics of shoulder morphology, plays a determinant role in the presence or absence of pseudoparalysis in shoulders with massive RC tears