Duration Of Immobilization Research Articles

ЭПИДЕМИОЛОГИЯ, ФАКТОРЫ РИСКА, ДИАГНОСТИКА И ПРОФИЛАКТИКА ТРОМБОЗА ГЛУБОКИХ ВЕН ПРИ ПЕРЕЛОМАХ ДЛИННЫХ КОСТЕЙ НИЖНИХ КОНЕЧНОСТЕЙ

A literature review presents a data concerning the incidence and risk factors for development of venous thromboembolic complications (VTEC), as well as their diagnosis and prevention in long bones fractures of the lower extremities (LBFLE). Literature data show that, despite the widespread implementation of preventive measures in case of LBFLE, it is not always possible to completely avoid VTEC. The main risk factors for their development are the injuries’ severity, the location and nature of the extremity bone fracture, the duration of immobilization, the amount of surgery performed for bone fragments stabilization, as well as age and the presence of concomitant diseases. In the diagnosis of thrombotic process, laboratory and radiation research methods play an essential role, and according to data they has varying degrees of sensitivity and specificity. However, to date, none of them has absolute diagnostic accuracy. Complex thrombosis prophylaxis significantly reduces the risk of VTEC development, however, the choice of the type and dosage of anticoagulants, as well as the duration of their use, remain controversial, and some authors recommend different approaches in this issue. In addition, the diagnostic criteria and therapeutic tactics for embologenic floating thrombi remain open for discussion. In this regard, the conduct of large randomized scientific studies aimed at early diagnosis, prevention and treatment of VTEC using modern diagnostic tests and new generation anticoagulants is relevant and allows to minimize the risk of disability and death.

Temporary Application of a Tarsal Arthrodesis Plate as a Postoperative Immobilization Technique in Common Calcaneal Tendon Injury Repair in Dogs: A Pilot Study

Objective: To determine if the temporary application of a pantarsal arthrodesis plate would provide adequate postoperative tarsal immobilization after calcaneal tendon repair and to identify complications compared to an established technique. Study Design: This was a single institution retrospective pilot study. Medical records of dogs from January 2008 through September 2019 that presented for common calcaneal tendon injury and underwent surgical repair were reviewed. Exclusion criteria included cases that had incomplete medical records or had insufficient follow up. 17 calcaneotibial (CT) screw and 10 temporary tarsal arthrodesis plate (TTAP) cases were included in the final analysis. Data collected included signalment, pertinent history, injury type, surgical technique, duration of postoperative immobilization, major postoperative complications that warranted a second procedure, and follow up time. Results: The major complications in the CT screw group were tendon re- injury (n=5), surgical site infection (n=1), and tendon laxity (n=1). The major complication in the plate group was tendon laxity (n=1). The median follow up time after initial surgery was 171 (range 36-1670) and 185 (range 57-567) days for the CT screw and TTAP groups, respectively. Conclusion: The results from this pilot study suggest that a TTAP is an acceptable method for postoperative immobilization after primary calcaneal tendon repair. Further research is warranted to validate this procedure.

Complex effect of caffeine and dioxidine on behavioral responses in mice in Porsolt test

Relevance. In light of the popularization of the use of caffeine-containing products, the question of the combined use of caffeine with substances exhibiting a toxic effect remains open. The doses of caffeine, which have a pronounced antidepressant effect, are also insufficiently studied. The aim of the study was to study the effect of repeated administration of caffeine and dioxidine on the behavioral responses of mice in the Porsolt test. Materials and methods. The experiment was carried out on 36 outbred male mice, divided into 6 groups. Experimental groups for 15 days of the study received caffeine at a dose of 40 mg/kg (first) or 100 mg/kg (second), dioxidine at a dose of 200 mg/kg (third), together with caffeine 40 mg/kg or 100 mg/kg, and dioxidine (fourth and fifth groups, respectively). The animals of the control group were injected with saline. To study the behavior, the Porsolt test was carried out, evaluating the following indicators on the 1st, 8th and 15th days of the experiment: the total time of immobilization, active swimming, climb, the number of grooming and shaking off acts. Results . The administration of caffeine at a dose of 40 mg/kg caused an increase in the time of active swimming and a decrease in the duration of immobilization on the 8th and 15th days. When caffeine was used at a dose of 100 mg/kg, an increase in the time of active swimming was noted with a single exposure, with an experiment duration of 8-15 days, an increase in the duration of immobilization was observed. Dioxidine caused a significant decrease in the time of active swimming and an increase in the duration of immobilization during all days of the experiment. The combined use of caffeine (40 mg/kg and 100 mg/kg) and dioxidine on the 1st day led to a decrease in immobilization and the time of active swimming. In both groups, 100 % animal mortality was observed by the 15th day. Conclusion. The results of the study indicate the presence of an antidepressant effect in caffeine at a dose of 40 mg/kg on the 8th and 15th days of the experiment and the absence of this effect in caffeine at a dose of 100 mg/kg with a duration of administration of 8-15 days. The use of dioxidine led to the absence of antidepressant activity and the presence of the opposite effect. The combined administration of caffeine (40 mg/kg and 100 mg/kg) and dioxidine led to 100 % mortality in the experimental groups by the 15th day of the experiment

Do predators react differently to dangerous and larger prey? The case of a mygalomorph generalist spider preying upon insects

Prey morphology and size are known to influence a predator’s decision to attack and consume particular prey; however, studies that evaluate both traits simultaneously are uncommon. Here, we first described the trophic niche in the mygalomorph spider Paratropis sp. These spiders have a narrow trophic niche and feed mainly on sympatric species such as larvae of lepidopterans and of beetles such as carabids, passalids and scarabeids. Second, we evaluated the effect of prey taxon and size on acceptance and immobilization duration, and built an ethogram of the predator’s behaviors. For each prey taxa, we offered large (approximately same size than the spider) and small larvae (approximately half of the size of the spider) of the aforementioned prey. We classified carabid beetle larvae as the most dangerous prey because of their sharp mandibles and predatory habits, followed by scarabeid larvae; lepidopteran and passalids larvae were considered to be non-dangerous prey. We did not find a significant effect of prey taxon or size on spiders’ acceptance. Prey size did not affect the time invested on each behavioral category, but prey taxon did. Moreover, although spiders used a similar strategy for capturing prey, they spent more time biting carabid larvae than other prey. Our results suggest that, at least in our study area, prey that are dangerous or the predator’s size do not seem to affect Paratropis sp. acceptance per se, but can cause the predator to change the time budget allocated to each behavior.

Complications in places of percutaneous coronary interventions: comparison of manual compression and clip application devices to achieve hemostasis

Vascular closure devices, used for over 20 years as an alternative to manual compression to achieve hemostasis. Although the clinical effi cacy and safety of clip application devices type VCD have been confi rmed in several studies, their use remains controversial due to complications in the access by using these devices. The purpose of this study — comparing the frequency of formation of regional vascular complications , risk factors for these complications, hemostatic time, duration of immobilization, the period of stay in hospital and the patients comfort level after percutaneous coronary interventions (PCI) with the traditional manual hemostasis and using VCD. For a retrospective analysis of medical records were selected 246 adult patients from City Hospital of Moscow n.a. M.P. Konchalovskiy, SMRC in Moscow which was performed PCI. The main group, where hemostasis after endovascular procedures was achieved with the help of clip application device StarClose SE (Abbott Vascular), made up of 128 patients, control group — 118 patients with carrying out manual hemostasis. Evaluation of subjective sensations (pain, numbness, etc.) was carried out using a rating scale. The frequency of complications in the study group was 6.25% in the control group — 6.78%. The comfort level of patients was higher in the study group. The results showed that the use of StarClose device to achieve hemostasis after PCI does not increase the frequency of regional vascular complications compared with manual hemostasis. At the same time, the use of vascular closure devices is an eff ective way to reduce hemostasis time, can reduce the period of immobilization of the patient, which increases patient comfort and reduces the patient’s stay in the hospital.

Ulnar Shortening Osteotomy for Ulnar Abutment Syndrome: The Results of Metaphyseal and Diaphyseal Osteotomies.

Background: The purpose of this study was to report the results of metaphyseal and diaphyseal ulnar shortening osteotomies (USO) for the treatment of ulnar abutment syndrome (UAS). Methods: From 2011 to 2016, we performed metaphyseal USO in 8 patients (8 wrists) and diaphyseal USO in 6 patients (7 wrists). The results were investigated in terms of bone union and cast immobilization, wrist and forearm range of motion (ROM). The mean follow-up duration was 29 months. Results: All 14 patients had bone union. The mean duration of bone union in metaphyseal USO and diaphyseal USO were 3.5 months and 4.3 months and the duration of cast immobilization after surgery were 24.2 days and 29.2 days. The mean forearm ROM (degree) were 134.3 (pronation/supination: 66.7/67.6) and 169.3 (pronation/supination: 84.3/85.0) at 3 months after surgery and 173.4 (pronation/supination: 86.0/87.4) and 172.8 (pronation/supination: 87.1/85.7) at 6 months after surgery. Conclusions: The results from this study suggest that metaphyseal osteotomies are an effective alternative to diaphyseal osteotomies for the treatment of ulnar abutment syndrome. Although metaphyseal osteotomies were associated with temporary decrease of pronation, this discrepancy resolved at 6 months postoperatively. Metaphyseal USO has the potential to promote primary bone union and appears to be an alternative treatment for UAS.

Rehabilitation following proximal humeral fracture in the UK National Health Service: A survey of publicly facing information.

Proximal humeral fractures (PHF) are a common injury in the older population but there is limited research evaluating rehabilitation following PHF. The aim of this study was to understand current National Health Service (NHS) practice for rehabilitation following PHF as a platform for conducting future research. Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of NHS Trusts that included detail about rehabilitation following PHF, for example, duration of immobilisation. One reviewer extracted data and a second reviewer verified this. Seventeen PIS from 17 different NHS trusts were identified. All provided some information on the method of immobilisation but only six provided guidance on duration of immobilisation with the median time being 2 weeks (range 0-6). The median time to commencement of passive exercise was 2 weeks (range 0-4) and 9 weeks (range 6-12) for active exercise. Only one PIS reported on the time for commencement of resisted exercises and this was reported as 6 weeks. The median time recommended return to work was 7.5 weeks (range 6-12). This study found limited publicly available information for rehabilitation following PHF in the NHS but offers some insight into current approaches. Our results will facilitate development of relevant information for patients and evaluation of rehabilitation strategies in future research.

Tips and Pearls in Chronic Subdural Hematoma

Background and Aim: One of the most prevalent neurosurgery conditions is Chronic Subdural Hematoma (CSDH). Among neurosurgeons, there are various CSDH treatment approaches. Methods and Materials/Patients: This is a narrative review examining the various aspects of the CSDH. To provide up-to-date information on CSDH, we concisely reviewed the related articles. All of the relevant articles retrieved from Google Scholar, PubMed, and Medline were reviewed and critically analyzed. We searched for keywords including chronic subdural hematoma, burr hole craniotomy versus craniostomy, middle meningeal artery embolization, conservative therapy versus surgical therapy in CSDH, and recurrence of CSDH in published articles from 1960-2020. Results: CSDH may present with various clinical presentations. Medical symptoms range from general and moderate symptoms (such as headache, tiredness) to severe symptoms (e.g. hemiparesis, coma). A definite trauma history may be obtained in most cases. Contrast-enhanced CT or MRI may help diagnosis. The treatment choice for uncomplicated CSDH is Burr-Hole Craniotomy (BHC). The use of drainage to decrease recurrence rates has been shown to have limited outcomes in most recent studies. Craniotomy is also used for treatment. Only asymptomatic or high-risk operative patients are subjected to non-surgical management. Conclusion: Management of CSDH is still contentious. It is widely agreed that if neurological signs and radiological observations are present, CSDH should be evacuated. Burr-hole craniotomy appears to be the preferred surgical technique because, in most patients, it gives the best treatment outcomes. Several issues are still uncertain, including the proper surgical technique [Burr-hole craniotomy versus Twist Drill Craniostomy (TDC) and craniotomy], the advantage of 2 perforated holes over one, the location of drainage, the impact of irrigation of the hematoma, and the duration of post-operative immobilization.

Outcome of Cancellous screw vs K wire fixation for management of neglected lateral condyle fracture of humerus in children

Introduction: This study compares the outcome of two treatment modalities of fixing neglected lateral condyle fracture of humerus in children in terms of clinical and radiological outcomes.Materials and Methods: All patients presenting to our institution were screened for eligibility by clinico-radiological evaluation. Patients were randomized into two groups i.e. Cancellous screw (CS) fixation (group I) and K wire fixation (group II). Patients were treated by open reduction and internal fixation using CS or K wires of appropriate size accordingly. (21 patients in group I and 19 patients in group II). Bone graft was used in all patients to promote osteosynthesis. Average follow up of patients was 18 months (range 11-22 months). Final outcome was measured in terms of clinicoradiological union, immobilization time, loss of reduction, gain in range of motion and functional outcome measured by Liverpool elbow score.Result: 21 patients were in group I (CS) and 19 patients were in group II (K wire). Mean age for group I and II was 7.9 and 7.5 years. Mean delay in presentation for group I and II was 14.9 and 13.2 weeks. Mean gain in range of motion (at final follow up as compared preoperatively) for group I and II was 23.5 and 17.8. Mean duration of immobilization for group I and II was 11.3 and 9.6 weeks. Mean LES score was 8.7 and 8.3 in group I and II. Union was seen in 37 cases. Three patients had pre mature physeal closure. Pin tract infection was seen in 4 patients in group II which healed by dressing and antibiotics. No patient had ulnar nerve palsy. Conclusion: Both techniques provide stable fixation, union and good functional outcome and there was no difference in the LES, however less immobilization and improvement in range of motion was seen in Group I (CS)

Effects of intracoelomic alfaxalone–dexmedetomidine on righting reflex in common garter snakes (Thamnophis sirtalis): preliminary data

ObjectiveTo evaluate the effect of dexmedetomidine on alfaxalone immobilization in snakes. Study designNonblinded, crossover study. AnimalsA total of eight mature common garter snakes (Thamnophis sirtalis). MethodsSnakes were administered each of three treatments intracoelomically: alfaxalone (30 mg kg–1; treatment A), alfaxalone (30 mg kg–1) combined with dexmedetomidine (0.05 mg kg–1; treatment AD0.05); and alfaxalone (30 mg kg–1) combined with dexmedetomidine (0.10 mg kg–1; treatment AD0.10). A minimum of 10 days elapsed between experimental trials. Times to loss of righting reflex (LRR) and return of righting reflex (RRR) were recorded. Heart rate (HR) was recorded every 5 minutes throughout the period of LRR and averaged for each snake. Times to LRR and RRR, and mean HR in snakes that achieved LRR were reported. ResultsLRR occurred in eight (100%), five (63%) and three (38%) snakes in treatments A, AD0.05 and AD0.10, respectively. For all treatments, time to LRR ranged 3–20 minutes. Median (range) times to RRR were 39 (30–46), 89 (62–128) and 77 (30–185) minutes for treatments A, AD0.05 and AD0.10, respectively. In animals where righting reflex was lost, mean HR was lower in all dexmedetomidine treatments compared with treatment A. Conclusions and clinical relevanceIn this pilot study, alfaxalone resulted in reliable immobilization, whereas dexmedetomidine and alfaxalone combinations resulted in highly variable durations of immobilization with low HR in immobilized animals. For snakes that achieved LRR, the addition of dexmedetomidine (0.05 mg kg–1) to alfaxalone appeared to extend the period of immobilization compared with alfaxalone alone.

The Effect of Adiantum Capillus-veneris L. Hydroalcoholic Extract on the Oxidative Stress Rate of Mice’s Blood and Brain in the Depression Model Caused by Acute Immobilization Stress

Background: The oxidant-antioxidants balance in the living organism is constantly challenged by internal and external pressures. Maidenhair or Adiantum capillus-veneris (Acv) is rich in bioactive compounds with antioxidant effects. 
 Objectives: The present study aimed at investigating the effect of Acv hydroalcoholic extract on the oxidative stress rate of blood and brain of mice in the depression model caused by acute immobilization stress.
 Methods: In this study, 40 male Balb/C mice were randomly divided into five groups, including 1 (control, 2, 3, and 4) intervention (receiving doses of 100, 200, and 400 Acv extracts) and diazepam group. Acute stress was induced by motion limitation (2 hours) and electrochemical shock (0.5 mA, 2 min), and then the mice were treated intraperitoneally with the extract or drug for 21 days. First, the rate of depression was assessed by forced swimming. Then, the Total Antioxidant Capacity (TAC), serum Malondialdehyde (MDA), and the MDA level of the brain were determined.
 Results: The prescription of different doses of Acv extract and diazepam significantly reduced the duration of immobilization in the forced swimming test compared with the control group (P<0.05). Besides, Acv extract at different doses of 200 and 400 significantly increased serum FRAP (TAC) and significantly increased TAC of the brain compared with the control group. Administration of Acv extract at different doses of 200 and 400 and diazepam significantly decreased serum MDA but significantly decreased MDA of the brain of mice compared with the control group (P<0.05).
 Conclusion: Acv extract can reduce the symptoms of depression and protect against acute stress-related oxidative stressors

How Long Should We Immobilize the Wrist after Vascularized Bone Grafting for the Treatment of Scaphoid Nonunion?

Background: Although vascularized bone grafting can effectively treat scaphoid nonunion, the optimal duration of the immobilization period after bone grafting is unclear. Therefore, we aimed to examine the difference in the union rate and range of motion between short and long immobilization periods and infer the optimal post-immobilization period after pedicled vascularized bone grafting for scaphoid nonunion treatment. Methods: A total of 23 wrists (21 men and 1 woman) with scaphoid nonunion treated using an intercompartmental supraretinacular artery pedicled vascularized bone graft were analyzed. We examined the difference in the union rate and range of motion between patients immobilized for less than 49 days (short immobilization group) and those immobilized for more than 49 days (long immobilization group). The range of motion of the wrist joint was measured before and after surgery. Patient outcomes were also assessed. Results: The overall union rate was 95.6%. A significant difference was found in postoperative extension and flexion between the two groups, but not in terms of the functional outcome. If the intraoperative fixation is solid, intraoperative proximal pole bleeding is confirmed, and the follow-up radiograph shows a normal healing process, we propose immobilization of the wrist for ≤ 7 weeks. Conclusions: The immobilization duration should depend on the solidity of intraoperative fixation and a satisfactory appearance on follow-up radiography: absence of a gap at the graft interface, surrounding lucency, or movement of the implant and displacement of the graft. If there are no signs of graft failure and fixation is solid, immobilization of the wrist for 7 weeks or less is recommended.

Researches of the imidazole and indole derivatives cerebroprotective activity and its impact on effects of antidepressants

Background. Treatment of depression disorders is insufficiently effectively. It uses for increasing of treatment efficiency empirical selected combinations of antidepressants with preparations of lithium and certain others, which possess cerebroprotective aside from psychopharmacological activity. Purpose. A study the spectrums of cerebroprotective activity of derivatives of benzimidazole - diacamph and of pyrrolo-oxindole - substance R-86 and referent preparation piracetam as well as its impact on ability of antidepressants to weaken the manifestation of behavioral depression evoked by chronic inflammation. Methods. It was investigated on slices of dorsal hippocampus in vitro by means of electrophysiological methods the impact of administrated during 10 days diacamph, substance R-86 and piracetam on evoked by deprivation of oxygen and glucose, 1 mM H 2 O 2 and 50 pM N-methyl-D-aspartate damages of pyramidal neurons. It was simulates in experiments in vivo behavioral depression evoked by chronic inflammationand researched impact of diacamph, substances R-86 and piracetam on evoked by antidepressants weakening of behavioral depression main manifestations. Results. It was ascertained, that chronic i/p administration diacamph, substance R-86 (10 mg/kg) and piracetam (100 mg/kg) rats reduced damages of hippocampal pyramidal neurons evoked by oxygen/glucose deprivation, oxidative stress and N-methyl-D-aspartate, i. e. drugs possess by cerebroprotective activity. In behavioral experiments investigate potentiating influence of diacamph and substance R-86 on affected imipramine, amitryptiline and ketamine duration of immobilization and marker of preference sucrose solution in rat behavioral depression evoked by chronic inflammation. Conclusion. Drugs with cerebroprotective action potentiate effects of traditional and fast-acting antidepressants.

Effects of Cast Immobilisation on Skin Barrier Function

Cast immobilisation remains the mainstay of treatment for various fractures in paediatric patients, yet patients commonly complain of skin irritation and discomfort. This study aimed to perform a qualitative and quantitative evaluation of the effects of cast immobilisation on the skin of children and adolescents. Patients aged 6-17 years of age with a fracture treated in a fiberglass short-arm or short-leg cast were recruited. Transepidermal water loss (TEWL), stratum corneum (SC) hydration, hair density and presence of any skin signs were assessed before and after cast. Patients were required to complete a weekly questionnaire to rate itch, malodour, warmth, and dampness of the skin under the cast. A total of 60 subjects completed the study. Thirty-six patients received a short-arm cast; 24 received a short-leg cast. Upon cast removal, TEWL was significantly increased on the volar surface of the arms and legs (P <0.05), and the dorsal surface of the arm (P <0.05). Likewise, SC hydration was significantly increased at most sites (P <0.05), except the volar surface of the leg (P = 0.513). There was no change in hair density. Throughout the duration of casting, there was an increase in itch and malodour scores. Moderate but significant changes in TEWL, SC hydration and subjective symptoms were observed during the duration of cast immobilisation, demonstrating that cast immobilisation for up to 4 weeks exerts moderate adverse impact on patients' skin. Further studies to explore the use of better materials for cast immobilisation to improve skin barrier function and overall patient satisfaction are warranted.

A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol

BackgroundCharcot neuroarthropathy is a complication of peripheral neuropathy associated with diabetes which most frequently affects the lower limb. It can cause fractures and dislocations within the foot, which may progress to deformity and ulceration. Recommended treatment is immobilisation and offloading, with a below knee non-removable cast or boot. Duration of treatment varies from six months to more than 1 year. Small observational studies suggest that repeated assessment with magnetic resonance imaging improves decision-making about when to stop treatment, but this has not been tested in clinical trials. This study aims to explore the feasibility of using serial magnetic resonance imaging without contrast in the monitoring of Charcot neuroarthropathy to reduce duration of immobilisation of the foot. A nested qualitative study aims to explore participants’ lived experience of Charcot neuroarthropathy and of taking part in the feasibility study.MethodsWe will undertake a two-arm, open study and randomise 60 people with a suspected or confirmed diagnosis of Charcot neuroarthropathy from five NHS, secondary care multidisciplinary Diabetic Foot Clinics across England. Participants will be randomised 1:1 to receive magnetic resonance imaging at baseline and remission up to 12 months, with repeated foot temperature measurements and X-rays (standard care plus), or standard care plus with additional three-monthly magnetic resonance imaging until remission up to 12 months (intervention). Time to confirmed remission of Charcot neuroarthropathy with off-loading treatment (days) and its variance will be used to inform sample size in a full-scale trial. We will look for opportunities to improve the protocols for monitoring techniques and the clinical, patient-centred and health economic measures used in a future study. For the nested qualitative study, we will invite a purposive sample of 10–14 people able to offer maximally varying experiences from the feasibility study to take part in semi-structured interviews to be analysed using thematic analysis.DiscussionThe study will inform the decision whether to proceed to a full-scale trial. It will also allow deeper understanding of the lived experience of Charcot neuroarthropathy, and factors that contribute to engagement in management and contribute to the development of more effective patient-centred strategies.Trial registrationISRCTN, ISRCTN74101606. Registered on 6 November 2017.

Correlation between Deep Venous Thrombosis and Inflammation in Patients after Implantation of Permanent Pacemaker

The correlation between postoperative deep venous thrombosis (DVT) and inflammation in patients with permanent cardiac pacemaker implantation was analyzed. A total of 130 cases undergoing permanent pacemaker implantation in the 305 Hospital of Chinese PLA and Fuwai Hospital from May 2014 to February 2017 were selected. Of the 130 cases, 60 patients complicated with DVT were selected as the observation group, and the remaining 70 cases without complications of DVT were selected as the control group. The relationship and influence of various factors were explored. The number of patients smoking and the number of subjects with DVT history in the observation group were higher than those in the control group. In the observation group, plasminogen activator inhibitor (PAI)-1: Ag, PAI-1: Ac, thrombin-activated fibrinolysis inhibitor (TAFI): Ag, and TAFI: Ac levels were higher than those in control group (P<0.05). The levels of inflammatory factors of the peripheral blood of the observation group were significantly higher than those of the control group (P<0.05). In the correlation analysis of serum inflammatory factors and coagulation factors, CRP, IL-6, IL-10 were positively correlated with PAI-1: Ag level. Age, BMI, smoking history, number of implanted electrodes, DVT history, duration of immobilization and inflammatory factor levels had independent predictive value on postoperative complicated DVT. The serum inflammatory factors are closely associated with postoperative DVT in patients implanted with permanent cardiac pacemaker, and the serum inflammatory factors are a good reference for the evaluation of DVT.

Long-term Stack splint immobilization for closed tendinous Mallet Finger.

Closed tendinous mallet finger can be treated non-operatively by extension splinting of the distal interphalangeal joint (DIPJ) for 6 to 8 weeks. However, method of conservative treatment in detail differs among various reports, especially in type of orthosis, duration of full-time immobilization and additional night orthotic wear after full-time immobilization. In our institution, full-time Stack splint is applied with distal interphalangeal joint (DIPJ) in extension for 12 weeks and night orthosis is worn for 4 weeks. The purpose of this study was to evaluate clinical and functional outcomes of tendinous mallet finger using our treatment protocol. Between March 2007 and December 2017, patients with tendinous mallet finger who were managed conservatively according to our treatment protocol were retrospectively reviewed. A total of 100 patients (101 cases) were enrolled, including 77 males and 23 females. Extension lag was measured before, soon after treatment, and at the final follow-up. Flexion angle of DIP joint was measured at the final follow-up. Patients were clinically evaluated based on the Crawford classification scale and Abouna & Brown criteria. The mean age of patients was 40 years and the mean follow-up was 48 months. The mean extension lag was 28.3 degrees initially and 2.6 degrees at the final follow-up. (p-value < 0.001) Flexion angle at the final follow-up was 68.3 degrees. Based on the Crawford classification scale, 56 % of patients had excellent results, and 25 % of patients had good results. According to Abouna & Brown criteria, 78 % of patients had success results and 7.5 % of patients had improved results. Wearing orthosis for up to 16 weeks (12 weeks full time and 4 weeks night orthosis) in the treatment of tendinous mallet finger injuries can achieve satisfying result.

FRI0617-HPR GRADED MOTOR IMAGERY IN POSTTRAUMATIC STIFFNESS OF THE ELBOW: A PILOT STUDY

Background:Elbow fracture is treated either conservatively or surgically followed by a period of immobilization with casting or splinting. A splint used to immobilize upper limbs for many weeks results in changes in both the peripheral musculature and the central nervous system. It is well known that common complaints after upper limb fractures include weakness, pain, and stiffness; therefore, pain management is important in the early stages of the rehabilitation of upper limb fractures.Objectives:This pilot study aimed to investigate the efficacy of graded motor imaginary (GMI) on pain, range of motion (ROM), and function in patients with posttraumatic stiff elbow.Methods:Fourteen patients with posttraumatic stiff elbow (6 women, mean age: 45.42 ± 11.26 years, mean body mass index: 24.29 ± 3.38 kg\m2and mean duration of immobilization: 4.75 ± 1.03 weeks) were randomly allocated to either GMI or control groups. The GMI group received GMI treatment in addition to a structured exercise program, and the control group received a structured exercise program (two days per week for six weeks) (Figure 1). The assessments included pain at rest and during activity using the visual analog scale (VAS), elbow active ROM with a digital goniometer (Baseline Evaluation Instrument, Fabrication Enterprises, Inc., White Plains, NY), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire (DASH). The assessments were performed at baseline and after the 6-week intervention.Figure 1.Graded motor imagery performed with mirror boxResults:After the 6-week intervention, there was a significant increase in elbow flexion-extension ROM and supination-pronation ROM, and improvement in DASH score in both groups (p&lt;0.05). However, improvement in VAS-rest and VAS-activity was significantly higher in the GMI group than the control group (p=0.03 and p=0.01, respectively).Conclusion:A conservative treatment program consisting of GMI treatment in addition to a structured exercise program applied twice a week for 6 weeks, has been found more effective in decreasing pain in the posttraumatic stiff elbow. It could be concluded that GMI is an effective treatment method for elbow fracture in patients with predominant elbow pain.

Chronic retinoic acid treatment induces affective disorders by impairing the synaptic plasticity of the hippocampus

BackgroundMore and more people are suffering from depression in modern society. It is believed that the development of depression results from alterations in synaptic transmission, especially in the hippocampus. Animal experiments and clinical studies have demonstrated that retinoids are essential components in hippocampal synaptic plasticity, and they have a close relationship with depression. However, it is still unclear how excessive retinoic acid (RA) causes depression and what synaptic and molecular mechanisms underlie it. MethodsBehavioral, electrophysiological, and molecular approaches were employed to characterize the effects of RA on depression and synaptic plasticity. RA was continuously administered intracerebroventricularly through an osmotic pump. ResultsRA treatment induced depression-like behaviors, as evidenced by decreased sucrose preference and increased immobile duration in both the forced swim test and the tail suspension test. RA administration also induced anxiety-like behaviors, indicated by decreased duration in the open arms of the elevated plus maze and the central of the open field. RA treatment decreased the neuronal excitability of the hippocampus either by changing the excitatory/inhibitory receptor balance or by promoting the synthesis of inhibitory neurotransmitters. Moreover, long-term potentiation was decreased in both the excitatory postsynaptic potential and the population spike in RA-treated rats, presumably a consequence of the reduced glur1 transcript level. LimitationsThe mechanism of how excess RA affects the hippocampal gene expression and synaptic plasticity requires further study. ConclusionsRA treatment can induce depression-like behavior in rats and impair hippocampal plasticity. Thus, improving synaptic plasticity in the hippocampus may ameliorate the affective disorders caused by excessive RA.

Comparing expert opinion within the care team regarding postoperative rehabilitation protocol following rotator cuff repair

There is no established consensus regarding the optimal rehabilitation protocol following rotator cuff repair, including duration of immobilization, timing to initiate range of motion and resistance exercises, and the importance of supervised, formal therapy. The purpose of this study was to determine agreement in opinion regarding rotator cuff rehabilitation between orthopedic surgeons and physical therapists (PTs). A 50-question survey was created on a secure data capture system and distributed via e-mail to members of professional organization affiliations. Surgeon participants were recruited from the American Shoulder and Elbow Surgeons, and PTs were recruited from the American Society of Shoulder and Elbow Therapists and the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Survey responses were analyzed for interprofessional differences in majority opinion and distribution of answer choices. A total of 167 surgeons and 667 PTs responded to the survey. Of the 39 questions evaluated, surgeons and PTs reached intraprofessional majority agreement in 26 (67%) and 28 (72%) statements, respectively, with agreements matching in 17 instances and differing in 4. The 2 groups had different answer preferences in 32 questions (82%). PTs were more likely to support shorter immobilization intervals (P < .001), earlier strengthening (P < .001), and more frequent home exercises (P = .002), whereas surgeons endorsed more conservative weight-bearing restrictions (P < .001), time-based phase transitions (P < .001), and web-based technological platforms for rehabilitation (P < .001). Our findings show that although significant discrepancy of opinion exists within professions, greater differences in preferences exist between surgeons and PTs regarding rotator cuff repair rehabilitation.