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Tape-stripping of the skin is a useful method for removing the stratum corneum and obtaining more information about the function of this skin layer as the main barrier for skin penetration. The amount of stratum corneum removed is of relevance in establishing the concentration profile of chemicals within the stratum corneum after topical application. Weighing is the preferred method for measuring the amount stripped, but because it is often subject to artifacts, alternative methods are sought. We present a simple, colorimetric method for determining the amount stratum corneum removed by sequential adhesive-tape-stripping of human skin in vivo. The method is based on quantification of the sodium hydroxide soluble protein fraction using a commercially available protein assay similar to the Lowry assay. The method is shown to be an accurate and reproducible alternative to weighing, also demonstrating uniform removal of stratum corneum layers following the very initial strips. [ABSTRACT FROM AUTHOR]

Adjuvant therapy in the treatment of breast cancer commonly refers to therapies that supplement primary treatment, traditionally mastectomy and, more recently, breast-conserving surgery. The present paper examines the evolution of systemic therapies and radiotherapy in their role as adjuvants to mastectomy, and offers a brief description of current treatment regimens for early and locally advanced disease. [ABSTRACT FROM AUTHOR]

The First Nordic Conference on Chemoresistance in Cancer Treatment was held in the Danish town of Helsingør on October 9th and 10th, 1997, under the auspices of the Nordic Cancer Chemoresistance Group (NCCG). The meeting focused on biochemical chemoresistance in a multidisciplinary approach. There were 19 oral and 15 poster presentations documenting recent advances in experimental and clinical research of drug transport mechanisms, DNA repair systems, detoxifying enzymes, drug target regulation, in vitro sensitivity tests, apoptosis inhibition, and strategies to circumvent chemoresistance. In the present paper we review the main issues that were addressed and discuss the findings with reference to the current literature in the field. The meeting demonstrated the plurality and the complexity of chemoresistance, which is a major obstacle to successful chemotherapy in cancer patients. The new insights to mechanisms of drug resistance and sensitization represent a useful basis for further development of strategies to circumvent chemoresistance in clinical practice. [ABSTRACT FROM AUTHOR]

In a multicentre study consecutively patch-tested dermatitis patients were tested simultaneously with 1.0% and 2.0% (w/v) formaldehyde in aqua applied with a micropipette (15 μl) to the filter paper disc in Finn Chambers (0.30 mg/cm2 and 0.60 mg/cm2, respectively). A total of 2,122 dermatitis patients were patch-tested. In all, 77 (3.6%) patients reacted positively to formaldehyde; 37 reacted only to 2.0%, 35 reacted to both concentrations and 5 patients reacted only to 1.0%. Significantly more patients were thus diagnosed with contact allergy to formaldehyde with 2.0% compared to 1.0% (p < 0.001) without causing more irritant reactions. The detected number of isolated allergic reactions to the 2 formaldehyde- releasers in the Swedish baseline series and not to formaldehyde itself raises the question whether quaternium-15 1.0% and diazolidinyl urea 2.0% should be present in the Swedish baseline series. [ABSTRACT FROM AUTHOR]

The author reflects on the impact of the open access (OA) policy of the journal which was implemented in January 2011. They say that the policy resulted in the increase of visits to the journal's web site, full research paper downloads increased to 1,084,500 in 2011, and paper submissions have remained at almost 400 papers per year. They add that doctor (Dr.) Lars Iversen of Denmark and Dr. Arthur Schmidtchen of Sweden has joined the journal staff as section editors.

The authors reflect on a working relationship which has developed between the periodical "Acta Oncologica" and the Nordic Association for Clinical Physics. They suggest that "Acta Oncologica" provides an excellent place for the association to publish papers on medical physics. They argue that the working relationship between the periodical and the association is based on mutual respect and understanding.

Heterogeneity in tumor sensitivity to therapy within patient populations is a major factor affecting tumor control probability (TCP) models, typically flattening dose-response curves. Knowledge of the major clinical factors affecting TCP would allow incorporation of these factors into TCP models, or stratification of patients and tumors, yielding steeper and more specific and predictive TCP curves. Methods. Literature review of the results of therapy for oropharyngeal cancer. Results. In recent years an improvement in control rates of cancers such as oropharyngeal cancer has been reported as potentially gained due to the dosimetric superiority of intensity modulated radiotherapy (IMRT). However, the emergence of Human Papilloma Virus (HPV)-related oropharyngeal cancer in recent years is an example of a major clinical factor which likely supersedes the dosimetric gains of IMRT. Conclusions. Clinical factors such as the example discussed in this paper: HPV-related oropharyngeal cancer, must be taken into account in TCP models in order for such models to be relevant. [ABSTRACT FROM AUTHOR]

A case report of fibrodysplasia ossificans progressiva in a 16-year-old boy is presented. The patient had developed a swelling over his left scapula and posterior chest well. The paper discusses the signs and symptoms, manifestation, diagnosis, and treatment and management of the disease. Relevant radiographs and photographs are provided.

Dermatoscopy increases the accuracy of diagnosis of melanoma. An atypical vascular pattern may be an indicator of cutaneous malignant melanoma (CMM). During dermatoscopy of certain CMMs numerous ruby droplets of blood appear when the dermatoscope is pressed firmly against the lesion. The aim of this paper was to examine the histopathological background for this observation. CMMs from 8 patients showing the poppyfield sign, i.e. squirts of ruby blood droplets, were paired with 8 CMMs of equal Breslow thickness not showing this sign. The 16 CMMs were placed in an unsystematic sequence and presented to two dermato-pathologists who assessed the lesions independently for confirmation of Breslow thickness, Clark level, ulceration and presence of dilated tumour vessels. There was no disagreement between the pathologists' assessments. Age of the patients and Breslow thickness of the cutaneous malignant melanoma were similar in the two groups. All 8 poppyfield CMMs had dilated tumour vessels compared with 25% (2/8) of the non-poppyfield CMMs (p< 0.007). Histological ulceration was observed in all poppyfield CMMs and none of the non-poppyfield CMMs (p< 0.001). The poppyfield bleeding sign is a dermatoscopic clue to dilated tumour vessels. It may be a dermatoscopic reflection of increased vascular density described in primary CMMs compared with adjacent skin and may also reflect the presence of primitive vessels in CMMs displaying increased fragility. [ABSTRACT FROM AUTHOR]

The author reports on the achievements of "Acta Oncologica" and offers a forecast of the future of the periodical. He relates that the quantity of articles getting published in the journal reflects the restrictions imposed in the acceptance of papers, with the aim of raising the average quality. He adds that the journal has an important role in spreading scientific knowledge.

The article discusses editorial developments for the journal "Acta Dermato-Venereologica" as of May 2014 including Nicole Basset-Seguin's replacement of Jonathan L. Rees as section editor for skin cancer-related papers and the expected number of papers to be submitted for publication in 2014.

The purpose of the present paper was to report cases of avascular necrosis of bone (AVNB) arising as a complication of chemotherapy for acute lymphoblastic leukemia (ALL). X-rays and [sup 99m]technicium-MDP bone scans were performed on patients with symptoms of bone pain, whereby five patients out of 850 patients were detected to have avascular necrosis of the femoral head. All had received aggressive chemotherapy with steroids. Two patients were still on therapy for the primary disease. In these patients further chemotherapy was continued without steroids. The median period from diagnosis of ALL to development of AVNB was 29 months. Three patients underwent corrective surgical procedures. To conclude, the data suggest that patients receiving combination chemotherapy, especially those with high cumulative doses, run a risk of developing AVNB. Awareness of this complication is important in order to have an early diagnosis so as to limit disability. [ABSTRACT FROM AUTHOR]

Collagen VI-related muscular dystrophies (COL6-RD) comprise a continuous spectrum of clinical severity, ranging from the most severe phenotype Ullrich congenital muscular dystrophy (UCMD), through intermediate phenotypes, to a milder Bethlem myopathy (BM) (1). These inherited diseases are caused by autosomal dominant or recessive mutations in the genes COL6A1, COL6A2 and COL6A3, which encode the main 3 α-chains of collagen VI, a component of the extracellular matrix (ECM) that is present in the vast majority of connective tissues and is implicated in its organization (2). The prevalence of COL6-RD is estimated as 0.77:100,000 in BM and 0.13:100,000 in UCMD (3). Clinical features are secondary to the dysfunction of the collagen VI in the ECM of muscle and connective tissues of tendons, subcutaneous and dermal layers of the skin (1, 2). BM is characterized by slow progressive weakness of the proximal muscles and contractures that characteristically involve multiple joints. Although the course of the disease is slowly progressive, many patients exhibit a marked decrease in muscle strength between the 4th and 5th decades, with approximately half of them becoming wheelchair-dependant after the 5th decade (1, 2). Cutaneous manifestations include: presence of keratosis pilaris, mostly in the extensor surfaces of proximal legs and arms; formation of abnormal scars, especially keloids, either spontaneous or after minor trauma; rough or dry skin; striae rubrae; cigarette paper scars; and, in younger patients with UCMD, soft velvety skin on the palms and soles (4-7). Preclinical studies have observed decreased tensile strength of the skin and altered collagen fibril and basement membrane architecture in Col6a1 null mice (8). We report here a case of spontaneous formation of keloids in a previously non-diagnosed BM patient who had 3 daughters also displaying features of BM. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the guest editor discusses a paper that presents the results of a survey among Scandinavian orthopedic surgeons on attitudes to treatment of displaced clavicle fractures.

A letter to the editor is presented in response to a paper by S. Mukka et al. concerning periprosthetic femoral fractures around a cemented, polished tapered (CPT) stem versus the anatomic SPII stem, which was published in a 2016 issue of the journal.

The article focuses on the history and the 80th anniversary of the journal "Acta Orthopaedica." The publication was founded in 1930 by a group of Scandinavian orthopedists and is owned by the Nordic Orthopaedic Federation in 2010. The journal continues to be printed in paper editions and can be accessed through the internet on the free database PubMed.

The author reflects on radioactive iodine in thyroid medicine in reference to several papers presented during the meeting on thyroid medicine in Umeå, Sweden in September 2005. He referred to S. Mattsson and L. Johansson's presentations of 36 different isotopes of iodine as the most frequently used for morphologic diagnosis. The author also cited the different measures in optimizing the use of radioactive iodine in treating thyroid cancer as presented by Gertrud Berg.

The article discusses the paper by Lars Carlsson and others on Gothenburg Osseointegrated Titanium (GOT) hip prosthesis. The said study compared the GOT hip to the Spectron/Trilogy cemented hip and reported that no loosening was found on both group. The author expresses that the new operative procedure will be useful to the orthopedic community.

The article introduces papers on fractures in the February 2006 issue of "Acta Orthopaedica."

Oligodontia is a rare condition, and only limited data are available on its prevalence. The present paper is based on data from Danish schoolchildren. When these data are combined with comparable data on Danish schoolchildren published previously by the senior author, it is shown that oligodontia occurs in 0.16% of the children (95% confidence interval, 0.07% to 0.30%). Two of every three congenitally missing teeth were upper or lower second premolars or upper lateral incisors. When data from Danish schoolchildren were combined with population data from similar groups of schoolchildren from the Nordic countries, the condition was found to be more frequent in girls than in boys (P = 0.05). [ABSTRACT FROM AUTHOR]

Details highlights of a symposium held on the occasion of the meeting of the Nordic Society of Dentistry for Children and the 80th Annual Meeting of the Scandinavian Association for Dental Research in Reykjavij, Iceland, in August 1997. Focus of the papers presented; Agreement among the speakers on the importance of population-based strategies in caries prevention; Discussion of the cost of preventing caries.

The article reports on editors, theme issues and performance of the journal "Acta Dermato-Venereologica." Co-editor and section editor Professor Torbjörn Egelrud has decided to retire from office and section editor Professor Artur Schmitdchen has accepted to become the new co-editor while Professor Lone Skov has accepted the role of section editor specialized in psoriasis and related disorders. The journal's impact factor has continued to rise and so are the submission of papers per year.

The author discusses some of the changes in the journal "Acta Dermato-Venereologica" (ADV). He cites the increase in the journal's impact factor to almost 2.0. He mentions that the journal's page volume was increased to 656 in 2008 to avoid queuing of accepted papers. He also announces that Professor Wilma Bergman and Doctor Lisa Naysmith have accepted the positions as Sections Editors from 2009.

The article announces the organizational changes that the journal undergoes with the inclusion of its new section editors and the new approaches applied in the publication of the journal. The author announces the new section editors of the journal which include Håkan Mobacken who will handle the clinical case reports and Elke Weisshaar, Heidelberg and Earl Carstens who will share responsibilities on papers submitted related to itching.

Presents the specific aims of the research papers on the aspects of outcome measurement in patients operated for lumbar spine problems, which were published in the June 3, 2005 issue of the periodical "Acta Orthopaedica." Assessment of test-retest reliability of the prospective data collection protocol in use by the Swedish Spine Register; Illustration of the use of recording visual analog scales for pain intensity in patients operated for lumbar spine problems; Determination of the preoperative SF-36 scores in patients scheduled for lumbar spine surgery.

Presents an erratum for a paper on the effects of positioning uncertainty and breathing on dose delivery and radiation pneumonitis prediction in breast cancer published in a previous issue of the periodical 'Acta Oncologica.'

Discusses the contents of the papers published in the March 2002 issue of the 'Acta Dermatologica Venereologica.' Treatment of alopecia areata; Respiratory infections associated with atopic dermatitis and other atopic diseases.

Presents an overview of papers in the September 2001 issue of 'Acta Dermato-Venereologica.' Skin tumors; Atopic dermatitis; Infectious diseases.

Comments on the paper by Kirby and colleagues on the possible involvement of cytomegaloviruses (CMV) and human herpes viruses (HHV) 6 and 7 in psoriasis. Main feature in plaque psoriasis; Possibility that specific human papillomaviruses could participate in epidermal hyperproliferation and autoimmune phenomena in psoriasis.

Presents announcements of various seminars, symposiums and other meetings on medical topics. Additional information which is provided on deadlines for the Fondation RenÉ Touraine Fellowships; Call for papers to be submitted for the Niels Hjort Prize.

Editorial. Presents information about research papers published in the May 1999 issue of the dermatology journal 'Acta Derm Venereol.' Discussion on the investigation of patients with suspected adverse reactions to systemic drugs; Focus on the treatment of chronic venous leg ulcers; Addressal to the issue of the dependence of steroid treatment on a switch between immunoglobulin G subclasses.

The article discusses a study for measuring perspiration using water erasable ink pen. It mentions that three volunteers were included in sweat test and starch iodine test. These tests were done on patients with hypohydrosis and cholinergic urticaria. It informs that the test was stoped within 10 minutes because the patient was complaining about urticaria. It discusses the need of further research for evaluation.

Objective: This study aims to assess the impact of proprioceptive training strategies with dual-task exercises on gait in people with chronic stroke., Study Design: Systematic review., Patients: Chronic stroke., Methods: Searches were conducted in accordance with PRISMA guidelines and PICOS criteria. PubMed, Web of Science, and Scopus databases were systematically searched from November 2020 to February 2022, for eligible clinical trials. Two independent reviewers thoroughly screened potential articles for relevance and assessed the methodology quality. In accordance with the GRADE, PICOS criteria, and Cochrane risk of bias tools, the authors included articles concerning the effectiveness of dual-task in proprioceptive training on gait parameters in people with chronic stroke., Results: Of 3075 identified studies, 11 articles met the inclusion criteria: 7 were randomized clinical trials, 1 was not randomized, and 3 were observational studies. The overall quality of evidence, assessed using the GRADE framework, was high, indicating a high level of confidence in the systematic review's findings. The papers involved 393 stroke patients; 241 underwent dual-task in proprioceptive training, with 152 participants in other stroke rehabilitation; within the dual-task group, 71 engaged in cognitive tasks, and 170 participated in motor tasks. dual-task in proprioceptive training improved gait speed, cadence, stride time, stride length, and step length. The best effects were observed with training 3 times a week for 4 weeks, with each session lasting 30 minutes, on speed, cadence, stride length, and step length., Conclusion: Current evidence suggests that proprioceptive training strategies with dual-task exercises improved walking abilities in people with chronic stroke. Specifically, it enhanced gait speed, a key indicator of clinical severity.

Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1]. By adhering to these guidelines, RSA studies will become more transparent and consistent in execution, presentation, reporting, and interpretation. Both authors and reviewers of scientific papers using RSA may use these guidelines, summarized in the Checklist, as a reference. Deviations from these guidelines should have the underlying rationale stated.

Objective: To identify and describe occupational and physiotherapy rehabilitation modalities used to support an interdisciplinary rehabilitation in adults (aged 16 + years) with concussion., Methods: A scoping review methodology was used. Included studies were categorized according to Wade's elements of rehabilitation and the Danish White Paper definition of rehabilitation., Results: Ten studies were included in this review, addressing: "assessment" (n = 9), "goal-setting" (n = 4), "training" (n = 10), and "social participation and discharge support" (n = 4). Interventions were delivered mainly by physiotherapists or an interdisciplinary team. In two studies occupational therapists were part of the interdisciplinary team. Randomized controlled trials more often addressed several of the rehabilitation elements using interdisciplinary intervention delivery. No studies specifically aimed their intervention at patients with acute or subacute concussion., Conclusion: The therapeutic modalities identified were: (i) manual and sensory motor interventions; (ii) physical exercises; and (iii) management of, or coping with, symptoms. More research is needed on how to better support social participation and discharge or return to work in the rehabilitation process. In addition, interventions delivered in the acute phases of concussion need further exploration.

Background: There is still no consensus on managing zone II level partial flexor tendon lacerations, and the management of zone II partial flexor tendon injuries is controversial. No reliable large cohort studies or metaanalysis papers on partial flexor tendon laceration management are available in PubMed or Embase. Methods: We searched PubMed, Embase, Cochrane Library, Insight, Scopus, and Web of Science databases for primary research articles investigating outcomes of patients with partial flexor tendon injuries. The initial search was limited to human studies that were published from 1970-2021 and indexed as randomized controlled or clinical trials or observational, cross-sectional, or cohort studies. We used statistical package R version 4.1.2 for this meta-analysis. Results: The Standardised mean difference (SMD) of the common effects model was 2.020 (95% CI; 1.583-2.457; P < 0.0001), indicating that the results of conservative treatment without surgical intervention are similar to surgical intervention or better in some articles. The SMD of the random effect model was 7.093 (95% CI; 1.090-13.096; P < 0.0206), indicating the same result. Higgins' I2 value was 97.6%, indicating serious heterogeneity. Conclusions: In this first meta-analysis on flexor zone II conservative treatment, five papers with publication bias were analyzed. It is meaningful to verify the result of conservative treatment statistically. Even though this is a heterogeneous paper, conservative treatment seems to have a lot of benefits for the patient, including offering a fairly solid longterm prognosis with very few complications.

Background and Purpose: A new periprosthetic joint infection (PJI) definition has recently been proposed by the European Bone and Joint Infection Society (EBJIS). The goals of this paper are to evaluate its diagnostic accuracy and compare it with previous definitions and to assess its accuracy in preoperative diagnosis., Patients and Methods: We retrospectively evaluated a multicenter cohort of consecutive revision total hip and knee arthroplasties. Cases with minimum required diagnostic workup were classified according to EBJIS, 2018 International Consensus Meeting (ICM 2018), Infectious Diseases Society of America (IDSA), and modified 2013 Musculoskeletal Infection Society (MSIS) definitions. 2 years' minimum follow-up was required to assess clinical outcome., Results: Of the 472 cases included, PJI was diagnosed in 195 (41%) cases using EBJIS; 188 (40%) cases using IDSA; 172 (36%) using ICM 2018; and 145 (31%) cases using MSIS. EBJIS defined fewer cases as intermediate (5% vs. 9%; p = 0.01) compared with ICM 2018. Specificity was determined by comparing risk of subsequent PJI after revision surgery. Infected cases were associated with higher risk of subsequent PJI in every definition. Cases classified as likely/confirmed infections using EBJIS among those classified as not infected in other definitions showed a significantly higher risk of subsequent PJI compared with concordant non-infected cases using MSIS (RR = 3, 95% CI 1-6), but not using ICM 2018 (RR = 2, CI 1-6) or IDSA (RR = 2, CI 1-5). EBJIS showed the highest agreement between pre-operative and definitive classification (k = 0.9, CI 0.8-0.9) and was better at ruling out PJI with an infection unlikely result (sensitivity 89% [84-93], negative predictive value 90% [85-93])., Conclusion: The newly proposed EBJIS definition emerged as the most sensitive of all major definitions. Cases classified as PJI according to the EBJIS criteria and not by other definitions seem to have increased risk of subsequent PJI compared with concordant non-infected cases. EBJIS classification is accurate in ruling out infection preoperatively.

Objective: To investigate how urological studies using composite endpoints as the primary outcome were cited., Materials and Methods: In this quality analysis of citations, three randomized clinical trials each investigating oncological and non-oncological urology were selected for citation analysis based on pre-defined criteria. In total, 531 papers citing the selected studies were reviewed; citations were evaluated based on whether they correctly referred to the composite endpoint and if singleton endpoints were defined and/or discussed., Results: Among the citations, 223/531 (42%) referred to the composite endpoint, of which 217/223 (97.3%) correctly cited the composite endpoint. However, only 91/217 (41.9%) defined and/or discussed the singleton endpoints of the composite endpoint. The lack of a validated instrument for citation analysis was a limitation of this study. Meanwhile, the main strength is the large number of individually analyzed citations., Conclusions: The composite endpoints of urological randomized clinical trials are generally cited without referring to the composite endpoint; when cited, the composite endpoints are described correctly. However, in most cases, without defining or discussing the singleton endpoints.

Background Rotator cuff tears are a common cause of shoulder pain and impairment. Subacromial glucocorticoid injections are widely used for treatment of epiphenomenons of chronic impingement syndrome with the possible side effects of tendon rupture and impaired tendon healing. Methods Using qRT-PCR, western blot, immunoflourescence, and measurement of 3H-thymidine uptake we investigated the effects of the crystalline glucocorticoid triamcinolone acetonide (TAA) when added to the culture medium of isolated human rotator cuff tendon cells. Results After 2 weeks of incubation, the cells had lost their fibroblastic appearance and parallel orientation, which is characteristic of cellular degeneration in vivo. Moreover, expression and secretion of collagen I was strongly reduced, and there was a decrease in proliferation rate. Cell migration was blocked and the rate of expression of the matrix metalloproteinases MMP2, MMP8, MMP9, and MMP13 was reduced, but expression of TIMP1 (a tissue inhibitor of MMPs) was upregulated, indicating a reduction in the cellular capacity for tendon repair. In addition, changes in cellular differentiation were observed: the number of adipocytes increased and levels of the protein Sox9—a marker of differentiating and mature chondrocytes—were elevated in triamcinolone acetonide treated cells. Interpretation These results may indicate that the use of TAA is one reason for weaker mechanical tendon properties and for the high rate of re-rupture after supraspinatus tendon repair. [ABSTRACT FROM AUTHOR]

Objective: To comprehensively compare the effectiveness of cold and heat therapies for delayed onset muscle soreness using network meta-analysis., Methods: Eight Chinese and English databases were searched from date of establishment of the database to 31 May 2021. Cochrane risk-of-bias tool was used to analyse the included randomized controlled trials. Potential papers were screened for eligibility, and data were extracted by 2 independent researchers., Results: A total of 59 studies involving 1,367 patients were eligible for this study. Ten interventions were examined: contrast water therapy, phase change material, the novel modality of cryotherapy, cold-water immersion, hot/warm-water immersion, cold pack, hot pack, ice massage, ultrasound, and passive recovery. Network meta-analysis results showed that: (i) within 24 h after exercise, hot pack was the most effective for pain relief, followed by contrast water therapy; (ii) within 48 h, the ranking was hot pack, followed by the novel modality of cryotherapy; and (iii) over 48 h post-exercise, the effect of the novel modality of cryotherapy ranked first., Conclusion: Due to the limited quality of the included studies, further well-designed research is needed to draw firm conclusions about the effectiveness of cold and heat therapies for delayed onset muscle soreness.

Objective: To determine the efficacy of repetitive transcranial magnetic stimulation vs sham stimulation on improving lower-limb functional outcomes in individuals with neurological disorders., Data Sources: PubMed, CINAHL, Embase and Scopus databases were searched from inception to 31 March 2020 to identify papers (n = 1,198). Two researchers independently reviewed studies for eligibility. Randomized clinical trials with parallel-group design, involving individuals with neurological disorders, including lower-limb functional outcome measures and published in scientific peer-reviewed journals were included., Data Extraction: Two researchers independently screened eligible papers (n = 27) for study design, clinical population characteristics, stimulation protocol and relevant outcome measures, and assessed study quality., Data Synthesis: Studies presented a moderate risk of selection, attrition and reporting bias. An overall effect of repetitive transcranial magnetic stimulation was found for outcomes: gait (effect size [95% confidence interval; 95% CI]: 0.51 [0.29; 0.74], p = 0.003) and muscle strength (0.99 [0.40; 1.58], p = 0.001) and disorders: stroke (0.20 [0.00; 0.39], p = 0.05), Parkinson's disease (1.01 [0.65; 1.37], p = 0.02) and spinal cord injury (0.50 [0.14; 0.85], p = 0.006), compared with sham. No effect was found for outcomes: mobility and balance., Conclusion: Supplementary repetitive transcranial magnetic stimulation may promote rehabilitation focused on ambulation and muscle strength and overall lower-limb functional recovery in individuals with stroke, Parkinson's disease and spinal cord injury. Further evidence is needed to extrapolate these findings.

Background and purpose - The trochanteric stabilizing plate (TSP) may be used as an adjunct to a sliding hip screw (SHS) in the treatment of trochanteric fractures to increase construct stability. We performed a scoping review of the literature to clarify when and how the TSP may be useful.Methods - A systematic search was performed in 5 databases and followed by a backwards-and-forwards citation search of the identified papers. 24 studies were included.Results - 6 biomechanical studies and 18 clinical studies were included in the review. The studies presented mainly low-level evidence. All studies were on unstable trochanteric fractures or fracture models. Due to the heterogeneity of methods and reporting, we were not able to perform a meta-analysis. In the biomechanical trials, the TSP appeared to increase stability compared with SHS alone, up to a level comparable with intramedullary nails (IMNs). We identified 1,091 clinical cases in the literature where a TSP had been used. There were 82 (8%) reoperations. The rate of complications and reoperations for SHS plus TSP was similar to previous reports on SHS alone and IMN. It was not possible to conclude whether the TSP gave better clinical results, when compared with either SHS alone or with IMN.Interpretation - The heterogeneity of methods and reporting precluded any clear recommendations on when to use the TSP, or if it should be used at all.

Background and purpose - The main purpose of arthroplasty registries is to collect information on patients, techniques, and devices to monitor and improve the outcome of the specific procedure. This study analyses the role played by registries in the orthopedic research community and describes publication trends, characteristics, and patterns of this field of research.Patients and methods - A descriptive-bibliometric review was conducted. Scopus was the database used for the research. All articles published from 1991 to December 2020 containing keywords related to registries and arthroplasty were considered. In particular, the following dimensions were analyzed in detail: (i) papers/year; (ii) journals; (iii) countries; (iv) research growth rate; (v) collaboration among countries. VOSviewer software was used to perform the bibliometric analysis. Finally, the 50 most cited papers of the last 10 years were briefly analyzed.Results - 3,933 articles were identified. There has been growing interest in the topic since 2010. Acta Orthopaedica ranked first for the number of articles published. The country with the largest number of articles citing registries was the United States, followed by the United Kingdom and Sweden. The relative number of articles per 100,000 inhabitants is 0.60 for Europe and 0.38 for the United States. The literature in this research area has an average yearly growth rate of 28%.Interpretation - The publication rate in the field of arthroplasty registries is constantly growing with a noteworthy impact in the evolution of this research and clinical area. The growth rate is significantly higher than that of arthroplasty literature (28% vs. 10%) and the collaboration among countries is strong and increasing with time.

Split thickness skin graft donor sites are challenging to manage in children because of patient fear and anxiety. Therefore, strategies that minimize the frequency of dressing change are beneficial. This paper describes a technique to simplify wound care for split thickness skin graft donor sites. A tumescent solution of saline containing 0.25% bupivacaine with epinephrine is infiltrated into the graft donor site. Skin grafts are harvested with an electric dermatome. The donor sites are dressed with AQUACEL ® Ag Foam, which is a sodium carboxymethylcellulose hydrofiber dressing that contains silver ions. A total of 17 split thickness skin grafts were performed with this technique. Patient age ranged from 2.4 year to 16.9 years (average 12 years). The AQUACEL ® Ag Foam dressings were removed at an average of 23 days (range 11 to 31 days) at which time complete donor site epithelialization was seen in 13/17 (76.5%) patients. The remaining 4 patients had < 5% of the donor site that had not epithelialized; these went on to heal uneventfully with a brief period of petrolatum gauze dressing changes. Two patients had foul smelling discharge under the dressing that resolved promptly with dressing removal. The above technique allows the primary dressing to stay in place long enough for epithelialization to take place. The obviation of dressing changes in the early post-operative period results in patient comfort and care giver convenience.

Meta-analysis of clinical trials in rehabilitation is often inconclusive, even when similar interventions are investigated. A possible reason for this is the influence of the settings in which rehabilitation services are delivered. Examples show that factors related to service organization in rehabilitation can influence study outcomes. This, in particular, is relevant, as contextual factors in rehabilitation are known to influence the participation and functioning of persons with disability. The Consolidated Statement of Reporting Trials (CONSORT) group and other initiatives published standards for reporting relevant factors for clinical trials. However, description of the rehabilitation setting of factors related to rehabilitation service provision is under-represented. Systematic reviews show that, on the one hand, these factors are scarcely reported, and only a few studies systematically evaluated the influence of factors related to service organization on rehabilitation outcomes. The International Classification of Service Organization in Rehabilitation (ICSO-R) provides a framework to systematically describe rehabilitation services. It contains 40 categories and sub-categories for the domains "provider" and "service delivery". Therefore, it is important and relevant to develop a minimum reporting set for factors relevant to service organization for rehabilitation trials. This paper sets out a methodological approach for this purpose, including literature reviews, Delphi survey focus group discussion, and consensus conference.

To date, pediatric hand transplantations have only been performed twice. The ethical issue most often discussed in the literature on this surgery concerns the risks of immunosuppression. While these risks are significant, they can be at least partially mitigated by selecting for patients who are already immunocompromised. Nevertheless, as we will argue, pediatric hand transplantation raises ethical issues that go beyond the risks of immunosuppression. In this paper, we focus on three additional ethical issues: the fact that pediatric hand transplantation aims to improve, rather than save life; the fact that it is an experimental surgery; and the fact that it will be performed on non-autonomous patients whose 'right to an open future' may potentially be undermined by the surgery. Taken together, we think that these considerations suggest that transplantation should be postponed until a child is mature enough to make their own decision about it.

Objectives: To provide a methodological reference paper for the inception cohort of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), by detailing its methodological features and reporting on participant characteristics, response rates and non-response bias., Design: Prospective cohort study starting in 2013 in all 4 specialized rehabilitation centres in Switzerland., Subjects: Included are 655 newly diagnosed first rehabilitation patients aged ≥16 years with traumatic or non-traumatic spinal cord injury (TSCI, NTSCI)., Methods: Descriptive statistics were used to depict participant characteristics and to compare characteristics of responders and non-responders. Logistic regressions were conducted to estimate non-response bias., Results: The sample consisted of 69% males, with mean age 53.5 years, 57.9% TSCI, 60.7% paraplegia and 78.8% incomplete SCI. Males and younger persons more often sustained TSCI and more severe SCI, resulting in longer duration of rehabilitation. Complete lesions were more prevalent in TSCI compared to NTSCI. The response rate was 47.5% and study participation was less likely in females, older persons, persons with lower functional independence and those with NTSCI., Conclusion: SwiSCI inception cohort data enable the estimation of epidemiological figures of SCI in Switzerland, and prognostic and trajectory modelling of outcomes after SCI to guide policy, service provision and clinical practice.

Background: Many patients have disabilities; it is therefore essential that medical education includes comprehensive teaching on disability and rehabilitation. In 2006 Hannover Medical School implemented an introductory course in the curriculum for medical students, on how to communicate with persons with disability and the need for rehabilitation. The course, entitled "Introduction to medicine", has the main goals of teaching the strategy and systematic approach of medicine to solving patients' problems., Methods: This paper describes the content, methods and outcomes of 1 of the 4 main themes of the "Introduction to medicine" course; the theme "Pain and disability", which is covered in the second week of the course., Results: Evaluation of the "Pain and disability" module found that students' ratings for the category "patient involvement" were very high (93%), whereas their ratings for the category "examination of student knowledge" were low. The overall rating of the module was "good" (10.8 out of 15 points), but not "very good"., Conclusion: The concept of the "Pain and disability" module is feasible and successful, even though it is scheduled early in the first year of the curriculum and approximately 350 students participate. Factors related to this success are: a mixture of teaching knowledge, supporting students' understanding, and applying communication and physical examination skills.