Significant Improvement In Grip Strength Research Articles

Dexamethasone-induced muscle atrophy and bone loss in six genetically diverse collaborative cross founder strains demonstrates phenotypic variability by Rg3 treatment

BackgroundOsteosarcopenia is a common condition characterized by the loss of both bone and muscle mass, which can lead to an increased risk of fractures and disability in older adults. The study aimed to elucidate the response of various mouse strains to treatment with Rg3, one of the leading ginsenosides, on musculoskeletal traits and immune function, and their correlation. MethodsSix Collaborative Cross (CC) founder strains induced muscle atrophy and bone loss with dexamethasone (15 mg/kg) treatment for 1 month, and half of the mice for each strain were orally administered Rg3 (20 mg/kg). Different responses were observed depending on genetic background and Rg3 treatment. ResultsRg3 significantly increased grip strength, running performance, and expression of muscle and bone health-related genes in a two-way analysis of variance considering the genetic backgrounds and Rg3 treatment. Significant improvements in grip strength, running performance, bone area, and muscle mass, and the increased gene expression were observed in specific strains of PWK/PhJ. For traits related to muscle, bone, and immune functions, significant correlations between traits were confirmed following Rg3 administration compared with control mice. The phenotyping analysis was compiled into a public web resource called Rg3-OsteoSarco. ConclusionThis highlights the complex interplay between genetic determinants, pathogenesis of muscle atrophy and bone loss, and phytochemical bioactivity and the need to move away from single inbred mouse models to improve their translatability to genetically diverse humans. Rg3-OsteoSarco highlights the use of CC founder strains as a valuable tool in the field of personalized nutrition.

Effect of pronator teres muscle botulinum neurotoxin type-A injection on proximal median nerve entrapment

PurposeWe aimed to evaluate the effect of botulinum neurotoxin type-A (Btx-A) injection into the pronator teres muscle in proximal median nerve entrapment (PMNE). MethodsIntramuscular injection of 30 IU Btx-A into the pronator teres muscle was performed in 12 patients (14 extremities) diagnosed with PMNE. The injection was made under nerve stimulator control. One patient with thoracic outlet syndrome was excluded from the study and not included in the clinical evaluation. Grip and pinch strength, 2-point discrimination, Q-DASH score, and pain on VAS were evaluated and compared before and 6–8 months after injection. The patients were contacted again by phone after the first and fifth years and asked about PMNE symptomatology. ResultsNone of the patients had complications. No significant difference in pinch strength was observed following Btx-A injection, but there was significant improvement in grip strength, 2-point discrimination, and Q-DASH and VAS pain scores. ConclusionThe outcomes of our study were promising: Btx-A injection improved symptoms in patients with PMNE. Level of evidenceLevel IV.

Effects of Low-Level Laser Therapy and Purified Natural Latex (Hevea brasiliensis) Protein on Injured Sciatic Nerve in Rodents: Morpho-Functional Analysis.

The present study analyzed the effects of low-level laser therapy (LLLT) and the purified natural latex protein (Hevea brasiliensis, F1 protein) on the morpho-function of sciatic nerve crush injuries in rats. One-hundred and eight male Wistar rats were randomly allocated to six groups (n = 18): 1. Control; 2. Exposed (nerve exposed); 3. Injury (injured nerve without treatment); 4. LLLT (injured nerve irradiated with LLLT (15 J/cm2, 780 nm)); 5. F1 (injured nerve treated with F1 protein (0.1%)); and 6. LLLT + F1 (injured nerve treated with LLLT and F1). On the 1st, 7th, 14th, and 56th days after injury, a functional sensory analysis of mechanical allodynia and mechanical hyperalgesia and a motor analysis of grip strength and gait were performed. After 3, 15, and 57 days, the animals were euthanized for morphometric/ultrastructural analyses. The treatments applied revealed improvements in morphometric/ultrastructural parameters compared to the injured group. Sensory analyses suggested that the improvements observed were associated with time progression and not influenced by the treatments. Motor analyses revealed significant improvements in grip strength from the 7th day in the LLLT group and in gait from the 56th day in all treated groups. We concluded that even though the morphological analyses showed improvements with the treatments, they did not influence sensory recovery, and LLLT improved motor recovery.

Impact of N-acetylcysteine supplementation on skeletal muscle myopathy in a mouse model of access-related hand dysfunction

Introduction: Hemodialysis is a life-line therapy for end-stage kidney disease patients that requires long-term arteriovenous access. Arteriovenous fistula (AVF) is the most durable and commonly employed access strategy. However, access-related hand dysfunction (ARHD) including ischemia, weakness, and neuromotor discoordination is prevalent (~50%) following AVF placement. Unfortunately, there are no pre-emptive non-surgical therapeutic studies available. We hypothesized that N-acetylcysteine (NAC) supplementation would attenuate hindlimb disability in a mouse model of ARHD. Methods: Adult male and female C57BL/6J mice (N=9/group) were fed adenine diet to induce kidney disease. Thereafter, animals were randomly allocated to receive NAC (150 mg/kg in 0.2 ml of 0.9% saline) or placebo (0.2 ml of saline) via oral gavage beginning 3 days prior to the AVF surgery and until euthanasia. Limb perfusion to the ischemic hindlimb and hindlimb grip strength were assessed post-operatively (POD) in vivo. Muscle contractile and mitochondrial function, and histological assessments of muscle and the neuromuscular junction were also performed. Results: Laser Doppler perfusion to the ventral paw was decreased immediately after AVF creation on the left common iliac artery (~25% of the contralateral limb) and recovered (~40-60%) at POD13 without a treatment effect. NAC treatment improved muscle mass in the tibialis anterior (TA) (+13~21%, P<0.05) and soleus (+17~21%, P<0.05) muscles in both male and female mice compared with placebo-treated animals. NAC female, not male, mice had significant improvement in grip strength (~20% greater at POD4 and POD12, P<0.05) and maximal mitochondrial respiration (~30% higher at POD14, P<0.05) compared with control animals. Muscle contractile function and myofiber area and capillarization in TA and soleus muscles were similar between NAC and placebo groups (P>0.05). Interestingly, the area of the post-synaptic acetylcholine receptor clusters was significantly greater in the animals that received NAC treatment (+10~22%, P<0.05) in both male and female mice. Conclusion: Daily treatment with a thiol reducing antioxidant, NAC, has beneficial effects on the recovery of muscle mass and neuromuscular junction morphology in both male and female mice with additional improvement in grip strength and mitochondrial function in female mice suggesting a potential therapeutic strategy targeting antioxidant defense to ameliorate ARHD. Funding Support: National Institutes of Health grant R01HL148597 and American Heart Association grant POST903198. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Efficacy and Safety of 6-Month High Dietary Protein Intake in Hospitalized Adults Aged 75 or Older at Nutritional Risk: An Exploratory, Randomized, Controlled Study

The aim of this study was to investigate the effects of increased dietary protein in daily-life settings in Japan for 6 months on the activities of daily living (ADL) in adults aged 75 or older at nutritional risk. The study was an open-label, exploratory, randomized controlled trial conducted at seven hospitals in Japan. The study participants were adults aged 75 or older who were hospitalized for treatable cancer, pneumonia, fractures, and/or urinary-tract infection at nutritional risk. The primary outcome was change in grip strength, skeletal muscle, and ADL indices (Barthel index, Lawton score). One hundred sixty-nine patients were randomly assigned to the intensive care (IC) or standard care (SC) group; the protein intake goals (g/kgw/day) were 1.5 for IC and 1.0 for SC. There was a significant improvement in grip strength only in the IC group (1.1 kg: 95% CI 0.1 to 2.1) (p = 0.02). While the skeletal muscle index and ADL indices were not significantly improved in either group, the improvement ratio tended to be greater in the IC group. There was no decrease in renal function in either group. Thus, intervention of increased dietary protein in daily-life settings for 6 months in adults aged 75 or older with treatable cancer, pneumonia, fractures, and/or urinary-tract infection and at nutritional risk may be effective in ameliorating loss of muscle strength.

Effects of Exercise Therapy and Nutrition Therapy on Patients with Possible Malnutrition and Sarcopenia in a Recovery Rehabilitation Ward.

We compared the effects of an exercise intervention with that of exercise combined with nutrition therapy in patients with possible malnutrition and sarcopenia admitted to a recovery rehabilitation ward, and we examined the differences in the patients' physical function and activities of daily living (ADLs). There were 16 patients in the Exercise group with exercise therapy and ADL exercises, and 14 patients in the Combined intervention group with exercise therapy, ADL exercises, and nutrition therapy. The survey items were body weight, body mass index, grip strength, lower-leg circumference, gait speed, and ADLs, each of which was measured at the baseline and at 2 weeks, 4 weeks, and at discharge. Significant improvements in grip strength were observed in the Combined intervention group as follows: at 4 weeks>at 2 weeks (p<0.05), and at discharge>baseline and 2 weeks (p<0.05). There were no significant changes in the Exercise group, and an interaction was recognized in both groups. Comprehensive rehabilitation including nutrition therapy is necessary for patients with possible malnutrition and/or sarcopenia, as our results indicate that nutrition therapy in addition to exercise therapy has the effect of promoting improvements of physical function in such patients.

Combined training improves the diagnostic measures of sarcopenia and decreases the inflammation in HIV-infected individuals.

BackgroundHIV‐related sarcopenia is an emerging health issue that often remains undiagnosed and can lead to reduced quality of life, independence, and premature death if untreated. This study investigated the effects of a 6 month combined training (resistance plus aerobic exercise) (CT) intervention on diagnostic measures of sarcopenia, including grip strength, appendicular lean mass index (ALMI), and gait speed.MethodsForty participants were randomized into either a CT group (n = 20; age = 38.3 ± 4.9 years) or a control group (CON; n = 20; age = 37.9 ± 5.1 years). Participants in the CT group performed three supervised sessions per week for 6 months, consisting of weekly reverse linear periodized resistance training followed by 20 min aerobic training. Participants in the CON group were instructed to continue with their current lifestyle habits. Assessments were completed at baseline and after 6 months. Statistical analyses were performed using a two‐way analysis of covariance (ANCOVA) adjusted for sex and preintervention values. Primary outcomes included grip strength, ALMI, and gait speed. Secondary outcomes were changes in levels of pro‐inflammatory cytokines (IL‐6 and TNF‐α), IGF‐1, and myostatin. Associations were explored between changes in inflammatory markers (IL‐6 and TNF‐α), gait speed, and ALMI with grip strength.ResultsA significant increase in ALMI was found for CT compared with CON (0.29 ± 0.13 kg/m2 vs. −0.11 ± 0.14 kg/m2, respectively; P < 0.001). Significant improvements in grip strength (7.86 ± 8.50 kg for CT vs. −1.58 ± 2.47 kg for CON) and gait speed (0.16 ± 0.07 m/s2 for CT vs. −0.06 ± 0.52 m/s2 for CON; both P < 0.001) were also observed in CT compared with CON. Reduction in inflammatory biomarkers was found in CT compared with CON (IL‐6; TNF‐α, both P < 0.001). An increase in IGF‐1 (74.36 ± 56.64 pg/mm3 for CT vs. 7.19 ± 99 pg/mm3 for CON; P < 0.001) and a decrease in myostatin (−158.90 ± 62.03 pg/mm3 for CT vs. −43.33 ± 146.60 pg/mm3 for CON; P < 0.001) was found following CT compared with the CON group. Change in grip strength was correlated with changes in IL‐6 (r = −0.65, P < 0.001), TNF‐α (r = −0.63, P < 0.001), gait speed (r = 0.63, P < 0.001), and ALMI (r = 0.54, P = 0.001), but not IGF‐1 and myostatin. No adverse events were recorded, and compliance with the CT exercise sessions was high (>85%).ConclusionsCombined training appears to be an effective means to counteract sarcopenia and improve various inflammatory markers and growth hormones in people living with HIV.

Effect of ICT-based Rehabilitation Exercise Program on Upper Extremity Muscle Strength and Compliance in Healthy Adults

The purpose of this study was to study the effect of an Information and communication technology (ICT)-based rehabilitation exercise program on upper extremity function and compliance of the health adults. A total of 20 subjects were enrolled in this study and assigned to an experimental group and a control group. The experimental group performed upper extremity exercises using an ICT-based rehabilitation exercise program, while the control group performed self-exercise without exercise equipment. Interventions were provided for 4 weeks, 4 times a week, 30 minutes per day in both groups. For primary outcome measurement, Handgrip were measured using a dynamometer, and for secondary outcome measurement, compliance with rehabilitation exercise was measured using a numeric rating scale. As a result of this study, the experimental group not only showed a statistically significant improvement in grip strength but also showed higher motivation and fun/interest in exercise compliance than the control group (all, p < 0.05). Therefore, this study suggests that the ICT-based rehabilitation exercise program can be an effective rehabilitation program in a clinical setting.

Effect of hand exercises on grip strength and manual dexterity in children with severe congenital visual impairment

Background: Vision is important in planning and performing motor skills. Early reduction or lack of visual function may alter or delay the development of basic motor and visual-motor skills. Developing skilful hands is a necessity in blind children as it often compensates for their missing vision. Objective: The objective of the study was to focus on the efficacy of hand exercises on grip strength and manual dexterity in children with severe congenital visual impairment. Materials and Methods: The study included 60 children aged 7–15 years who were diagnosed with severe bilateral congenital visual impairment. Hand exercises were given to all the 60 children at least 4 days in a week for a period of 6 weeks. Grip strength and manual dexterity values were analyzed using Jamar dynamometer and Purdue Pegboard test, respectively. Results: The mean age was 12.15±2.284 years. We observed a significant improvement in grip strength (p&lt;0.001) and manual dexterity (p&lt;0.001) post-intervention as compared to the pre-intervention scores. Conclusion: The findings of the present study indicate that hand exercises can be a useful training method in improving grip strength and manual dexterity in children with severe congenital visual impairment.

What are the effects of expanding social pension on health? Evidence from the Basic Pension in South Korea

• The health effect of social pension expansion among older Koreans is examined. • The expansion was associated with an 8.1–9.0% reduction in depressive symptoms. • Improved subjective well-being was the likely pathway that led to reduced depression. • The reform had no discernible impact on grip strength and self-rated health. • Mortality benefits are likely through suicide prevention among the depressed. Non-contributory social pension has been widely used to provide minimum income support for disadvantaged seniors. Despite its efficacy in reducing old-age poverty, only a few studies systematically assessed whether the benefits of social pension extend to health outcomes. In this paper, we exploit a reform to the South Korean social pension in 2014 to provide evidence on the health effects of expanding social pension. Using data from the Korean Longitudinal Study of Aging, we estimate a series of difference-in-differences models that compare changes in health of individuals age-eligible for the social pension (age ≥ 65) to those younger than the minimum qualification age (age < 65), before and after the reform in 2014. The estimates show an average of 8.1–9.0% reductions in the count of depressive symptoms attributable to the reform. We also find that the mental health benefit comes primarily from beneficiaries being more satisfied with their financial condition and overall quality of life. However, despite the large increase in income there were no significant improvements in grip strength and self-rated health. Overall, this study highlights the importance of social pension as a means of protecting mental health of disadvantaged seniors.

Effect of Complex Exercise Programs on Physical Fitness, Activities of Daily Living and Cognitive Status in Frail Elderly

본 연구는 허약 노인을 대상으로 복합운동프로그램 실시에 따른 체력, 일상생활수행능력과 인지상태의 변화를 알아보는데그 목적이 있다. 연구 대상은 21명의 허약노인을 대상으로 하였으며, 복합운동프로그램 운동그룹 12명, 통제그룹 9명으로 구성하였다. 복합운동프로그램은 유산소 운동 중심의 노인건강체조와 인지상태향상과 체력 향상을 위한 4색 래더 운동으로 구성되어 있으며 주2회, 1회 60분 운동을 10주간 실시하였다. 운동 프로그램 적용 전·후에 근력(상지, 하지), 유연성(앉아서 윗몸 앞으로 굽히기), 민첩성(전신반응시간), 보행능력, 협응성(Timed Up and Go test), 일상생활수행능력, 인지상태를 측정하였다. 허약 노인에 복합운동프로그램의실시 유무에 따른 집단 간의 차이를 연구한 결과 운동그룹은 상지근력(악력)에서 통제 그룹과 비교하여 유의한 향상이 있었고, 일상생활수행능력(ADL) 역시 유의한 향상을 나타냈다. 본 연구의 결과를 종합하면 허약 노인의 복합운동프로그램 참여는 근력(악력) 향상에효과가 있으며, 다양한 신체 기능 및 인지상태 저하를 위한 예방 차원에서 효과가 있었다.The purpose of this research was to examine changes in the physical fitness, activities of daily living performance, and cognitive status of the frail elderly by combined exercise programs. The combined exercise program consisted of an aerobic exercise for the elderly and a four-color ladder exercise for improving of cognitive ability and physical fitness. Twenty-one frail elderly participated in this study, they were divided into 12 exercise groups and nine control groups. The exercise group conducted the combined exercise program of 60 minutes, twice a week, for10 weeks, while the control group maintained their normal lives. Strength, flexibility, agility, coordination, ADL and MMSE-K were measured. Exercise group showed significant improvement in grip strength compared to control group. In addition, ADL showed significant improvement only in the exercise group. The results of this study showed that participation in the combined exercise program of the e l derl y was effective in improving the grip strength, and in preventing various physical functions and cognitive conditions decline.

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

No consensus has been reached to date regarding the optimal treatment for distal radius fractures. The international rate of operative treatment has been increasing, despite higher costs and limited functional outcome evidence to support this shift. To compare functional, clinical, and radiologic outcomes after operative vs nonoperative treatment of distal radius fractures in adults. The PubMed/MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception to June 15, 2019, for studies comparing operative vs nonoperative treatment of distal radius fractures. Randomized clinical trials (RCTs) and observational studies reporting on the following: acute distal radius fracture with operative treatment (internal or external fixation) vs nonoperative treatment (cast immobilization, splinting, or bracing); patients 18 years or older; and functional outcome. Studies in a language other than English or reporting treatment for refracture were excluded. Data extraction was performed independently by 2 reviewers. Effect estimates were pooled using random-effects models and presented as risk ratios (RRs) or mean differences (MDs) with 95% CIs. Data were analyzed in September 2019. The primary outcome measures included medium-term functional outcome measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the overall complication rate after operative and nonoperative treatment. A total of 23 unique studies were included, consisting of 8 RCTs and 15 observational studies, that described 2254 unique patients. Among the studies that presented sex data, 1769 patients were women [80.6%]. Overall weighted mean age was 67 [range, 22-90] years). The RCTs included 656 patients (29.1%); observational studies, 1598 patients (70.9%). The overall pooled effect estimates the showed a significant improvement in medium-term (≤1 year) DASH score after operative treatment compared with nonoperative treatment (MD, -5.22 [95% CI, -8.87 to -1.57]; P = .005; I2 = 84%). No difference in complication rate was observed (RR, 1.03 [95% CI, 0.69-1.55]; P = .87; I2 = 62%). A significant improvement in grip strength was noted after operative treatment, measured in kilograms (MD, 2.73 [95% CI, 0.15-5.32]; P = .04; I2 = 79%) and as a percentage of the unaffected side (MD, 8.21 [95% CI, 2.26-14.15]; P = .007; I2 = 76%). No improvement in medium-term DASH score was found in the subgroup of studies that only included patients 60 years or older (MD, -0.98 [95% CI, -3.52 to 1.57]; P = .45; I2 = 34%]), compared with a larger improvement in medium-term DASH score after operative treatment in the other studies that included patients 18 years or older (MD, -7.50 [95% CI, -12.40 to -2.60]; P = .003; I2 = 77%); the difference between these subgroups was statically significant (test for subgroup differences, P = .02). This meta-analysis suggests that operative treatment of distal radius fractures improves the medium-term DASH score and grip strength compared with nonoperative treatment in adults, with no difference in overall complication rate. The findings suggest that operative treatment might be more effective and have a greater effect on the health and well-being of younger, nonelderly patients.

EFFECT OF ß-HYDROXY-ß-METHYLBUTYRATE (HMB) ON MUSCLE STRENGTH IN OLDER ADULTS WITH LOW PHYSICAL FUNCTION

Objectives: To evaluate the effects of β-hydroxy-β-methylbutyrate (HMB) on muscle strength, physical performance, and muscle mass without additional exercise training in older adults with low physical function. Design: Randomized, controlled trial (Open-label study). Setting: Outpatients. Participants: 34 senior outpatients with low physical function who do not exercise regularly. Intervention: 2.4 g of HMB (3.0 g of calcium β-hydroxy-β-methylbutyrate [CaHMB]) per day was given for 60 days, and subjects in the control group were asked to engage in daily activities as normal. Measurements: Weakness or low function was defined by the Asian Working Group for Sarcopenia criteria, then the participants were assigned to the HMB group or the control group. All participants underwent several evaluations such as grip strength, the timed up and go test, the 5-times chair stand test (5CS), and skeletal muscle mass index by the bioimpedance method at baseline and at the end of intervention or control period. Results: An intragroup comparison of pre- to post-treatment values showed significant improvement in grip strength and the 5CS in the HMB group (grip strength: HMB, 16.6±6.1 kg to 18.2±6.4 kg, P=.001; control, 16.5±4.3 kg to 16.7±4.7 kg, P=.729; 5CS: HMB, 11.0 [8.8-13.0] s to 10.1 [8.5-12.6] s, P=.011; control, 11.1 [8.6-13.8] s to 10.0 [8.8-11.3] s, P=.246). Two-way repeated measures analysis of variance (ANOVA) used to compare the HMB and control groups showed a significant improvement in grip strength in the HMB group compared with the control group (P=.029). Conclusion: A supplementation of HMB without additional exercise may improve muscle strength in older patients with low muscle strength.

Therapeutic efficacy of mulligan’s mobilization versus low level laser therapy for the management of tennis elbow­: A comparative study

Background and Objectives: Tennis elbow is most common lesion of the elbow affecting the tendinous origin of the wrist extensors especially ECRB. In physiotherapy clinical practice, different outcome measures were used to evaluate functional recovery in tennis elbow. This study has used two outcome measures for evaluating the functional recovery in tennis elbow and they are Visual Analogue Scale (VAS) and grip strength. The objectives of this study to find out and compare the efficacy of Mulligan’s MWM Versus Mulligan’s MWM in combination with Low level laser therapy, to reduce pain and improve grip strength in Tennis elbow. The method used in subjects with known cases of chronic tennis elbow (three or more than three months) diagnosed by clinical confirmatory tests by the specialists; were chosen for the study. After dividing the subjects into 2 groups of 25 each, they were pre- tested using hand dynamometer for the grip strength and visual analogue scale (VAS) for pain intensity. The first group were given Mulligan`s Mobilisation with Movement and second group were given Low Laser Level Therapy and Mulligan`s Mobilisation with Movement for thrice a week for three weeks. The patients were assessed for pain intensity using visual analogue scale (VAS) and for grip strength using hand dynamometer by the end of third week. The results were computed and analyzed to see which group has better improvement. The results of the study in the group A, the VAS score came down from 6.32 to 3.28 by the end of third week of treatment and the grip strength increased from 11.36 to 14.96 lbs by the end of third week. In the group B, the VAS score came down to 2.08 from 6.48 by the end of third week. The grip strength increased from 11.68 lbs to 16.40 lbs by the end of third week. So, there was a significant improvement in grip strength and reduction in VAS in group A and group B. Also there was a significant improvement in grip strength and VAS in group B as compared to group A. The conclusion in this study, both the groups statistically showed significant response to their interventions. The mean score in case of VAS is less and in case of HGD is high for Mulligan`s MWM and Low Level Laser Therapy as compared to Mulligan`s MWM alone. Mulligan`s MWM and LLLT was found to be more effective than the Mulligan`s MWM alone to reduce the pain and to increase grip strength in treating Tennis elbow.

Four-corner fusion: Comparing outcomes of conventional K-wire-, locking plate-, and retrograde headless compression screw fixations

Several operative approaches and various implants for osseous fixation have been described to achieve four-corner fusion of the wrist. Given the discordance and to aid in further standardizing the technique, this study directly compares the outcomes of K-wire, fusion plate, and headless retrograde compressive screw fixations to achieve four-corner arthrodesis. Sixty-four patients underwent four-corner fusion over a period of 5 years and were reviewed retrospectively. Twenty-one patients underwent bone fixation with conventional K-wires, 26 with locking plates, and 17 patients were treated by headless retrograde compressive screw fixations. Patients of the different groups were comparable regarding age, sex, hand dominance, and stage of disease. All study groups showed significant improvements in grip strength, decrease in pain (NRS) at rest and with activity, range-of-motion of the wrist, and wrist function (measured by the DASH-score). When evaluating the three groups amongst each other, overall complication and nonunion rates were low and revealed no significant differences between the groups of patients. However, regarding postoperative NRS at activity, dorsal flexion, and DASH-scores, the "screw" group showed significantly better results than the "wire" group. The results show that all examined techniques of four-corner fusion can improve wrist function when compared to preoperative baseline (NRS at rest and activity, postoperative DASH-scores). However, headless retrograde compressive screw fixation had significant better results regarding pain relief (NRS) at activity and postoperative DASH-scores.

Can upper limb taping or exercises improve hand function, writing speed and self-perception of performance in adolescent school children?

The majority of students spend time in writing, which is a prime performance measure in examinations. Enhancement in handwriting should benefit students to attain better academic performance. To assess the effectiveness of taping and exercises on hand function, writing speed, self-perception of writing and to compare these techniques. A randomized control trial was conducted using cluster sampling in adolescent children across four schools in an urban city. A 4-week intervention study was conducted on 123 students divided into taping, exercise and control groups. Outcome measures were grip strength, pinch strength, 12-min writing speed test and the Writer Self-Perception Scale (WSPS). For intra-group analysis, a paired t-test was used for parametric values and the Wilcoxon signed rank test was used for non-parametric values. For inter-group analysis, one-way analysis of variance (ANOVA) for parametric values and the Kruskal-Wallis test for non-parametric values was used. The taping group showed a significant improvement in grip strength (1.79 kg; p = 0.00), pinch strength [1.67 lb (757.4 g); p = 0.00] and writing speed (39.77 words/12 min; p = 0.00). The exercise group showed significant improvement in grip strength (2.09 kg; p = 0.00), pinch strength (1.28 lb; p = 0.00), writing speed (28.38 words/12 min; p = 0.00). In the control group, there was a significant increase in pinch strength (1.023 lb; p = 0.01) and writing speed (12.94 words/12 min; p = 0.02). Inter-group analysis showed significant difference in writing speed (p = 0.002) and grip strength (p = 0.00). There was no significant difference in perception (p = 0.071). Taping and exercise are equally effective for enhancement of hand function, writing speed and self-perception in adolescent school children.

The Effectiveness and Safety of Tripterygium wilfordii Hook. F Extracts in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

Objective: To conduct a meta-analysis of the effectiveness and safety of Tripterygium wilfordii Hook. F (TwHF) extracts for the treatment of rheumatoid arthritis (RA).Methods: A systematic literature search was conducted in PubMed, EMBASE, Cochrane, Medline, CNKI, SinoMed and WanFang Library till 12 July 2017. All included studies were analyzed with the use of the Review Manager 5.2 software according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement protocol.Results: Fourteen randomized controlled trials (RCTs) were identified. TwHF extracts provided a statistically significant improvement in grip strength (GS), swelling joint count (SJC) and morning stiffness (MS) compared with placebo (P < 0.001). The meta-analysis showed significant differences between TwHF extract-treated group and the DMARDs group in GS, MS, C-reactive protein (CRP), and tender joint count (TJC) (P < 0.05), aside from ESR and SJC (P > 0.05). The pooled results also displayed significant differences between the combination of TwHF extracts with DMARDs and the DMARDs alone group in ESR, CRP, SJC, and TJC (P ≤ 0.05). For the safety analysis, two trials favored TwHF extract-treatment and one trial favored non-TWHF extract-treatment in AEs (P < 0.05). Eleven trials showed no statistically significant differences between TwHF extract-treated group and the DMARDs group (P > 0.05).Conclusions: The findings of this systematic review with meta-analysis indicate that TwHF extracts provides statistically significant and clinically important improvement in RA symptoms and has an acceptable safety profile.

The Effect of High Dose Vitamin D3 on Physical Performance in Frail Older Adults. A Feasibility Study.

Vitamin D deficiency is ubiquitous in frailty but the effectiveness of vitamin D supplementation to improve outcomes in frail individuals is unclear. It has been postulated that higher than the current recommended doses (800 IU/day) may be needed to achieve a neuromuscular effect in frail individuals. 1) determine if 4000 IU per day of vitamin D3 is safe for frail older adults; and 2) establish the efficacy of this dose to improve physical performance outcomes in this population. Open-label, feasibility study. Community retirement centre. 40 older adults with frail or pre-frail characteristics. 4000 IU of vitamin D3 and 1200 mcg of calcium carbonate daily for four months. Physical performance (grip strength, gait speed and short physical performance battery score), cognitive health and vitamin D and iPTH serum levels before and after the intervention. Frail individuals improved short physical performance battery score (1.19, p = 0.005), fast gait speed (4.65, p = 0.066) and vitamin D levels (7.81, p = 0.011). Only frail females made a significant improvement in grip strength (1.92, p = 0.003). Stratifying the sample by baseline vitamin D levels revealed that participants with vitamin D insufficiency (≤ 75 nmol/L) significantly improved short physical performance battery score (1.06, p = 0.04), fast gait speed (6.28, p = 0.004) and vitamin D levels (25.73, p = <0.0001). Pre-frail individuals, as well as those with sufficient vitamin D levels (> 75 nmol/L) made no significant improvement in any outcome. Vitamin D supplementation using 4000 IU/daily is safe and has a modest beneficial effect on physical performance for frail individuals and those with insufficient vitamin D levels. Participants with vitamin D insufficiency (≤ 75 nmol/L) showed greater benefits. Our feasibility study provides results to help calculate effect size for a future RCT.

Dorsal Wrist Plication for Midcarpal Instability.

Midcarpal instability (MCI) is a cause of chronic wrist pain for which treatment remains controversial. This study's purpose was to determine the outcome of a treatment algorithm for MCI that included immobilization and surgical interventions. We prospectively enrolled 23 consecutive patients (12 males, average age 27 years) with 27 symptomatic wrists. All had generalized wrist pain with an average duration of 22 months. All had MCI and a catch-up clunk that reproduced the symptoms. Initial treatment was full immobilization for 6 weeks. When necessary, recurrence after immobilization was treated with an anatomically based surgical procedure to plicate the dorsal capsule and extrinsic ligaments to stabilize the midcarpal joint. Failure of surgical plication was followed by 4-corner intercarpal arthrodesis when necessary. Patients were observed for instability, grip strength, wrist motion, and Patient-Rated Wrist Evaluation. For 22 wrists there was partial relief of symptoms with full-time cast or orthosis immobilization; however, symptoms quickly returned with mobilization. The other wrists had previously been immobilized and patients refused further nonsurgical care. All patients underwent surgical plication of the dorsum of the wrists. Postoperative follow-up (35 months) showed statistically significant improvements in grip strength and Patient-Rated Wrist Evaluation scores. All patients had improved pain at final follow-up. Most improvement was in female patients aged under 25 years, with hypermobility and without major traumatic or work-related injuries. This contrasted with poorer outcomes in men aged over 25years who had moderate or severe trauma that was mostly work-related. Instability recurred in 2 patients who then had a 4-corner arthrodesis. Immobilization was not successful in controlling pain and recurrence of instability in patients with MCI. Surgical midcarpal capsular plication was less effective in men with posttraumatic instability. The capsular plication procedure was successful in young female patients with ligament laxity and a history of only minor or repetitive trauma and no history of major trauma. Therapeutic IV.

Patient-Reported Outcome Following Ulnotriquetral Ligament Split Tear Repair.

While the clinical presentation and mechanism of injury of ulnotriquetral (UT) ligament split tear had been well described, there has been no other studies that has reported on the outcome of a UT ligament repair. This study aims to look at the patient-reported outcomes following UT ligament split tear repair. 18 wrists (13 right and 5 left) in 17 patients (12 males and 5 females, mean age 25.0 ± 8.4 years, range 16-50 years) who had UT ligament split tear and undergone surgical repair between November 2007 and December 2013 were retrospectively analysed. Patient-reported outcome of resolution of pain, and objective measurements such as improvement in grip strength and range of movement of the wrist were recorded. Patients were followed up until the pain was completely resolved or the last documented consultation. The mean follow-up duration was 16.2 months. 94% reported improvements post-surgery, of which 63% reported complete resolution of pain. 6% reported no improvement in pain post-operatively. No patient reported worsening of pain after the surgery. There was significant improvement in grip strength from a mean of 23.5 kg to 27.1 kg. There was no significant change in range of motion of the wrist. The majority of patients reported resolution or improvement of pain after surgical repair. In addition, there was statistically significant improvement in grip strength recorded.