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Investigating how differential gene expression underlies caste determination in the social Hymenoptera is central to understanding how variation in gene expression underlies adaptive phenotypic diversity. We investigated for the first time the association between differential gene expression and queen–worker caste determination in the bumble-bee Bombus terrestris. Using suppression subtractive hybridization we isolated 12 genes that were differentially expressed in queen- and worker-destined larvae. We found that the sets of genes underlying caste differences in larvae and adults failed to overlap greatly. We also found that B. terrestris shares some of the genes whose differential expression is associated with caste determination in the honeybee, Apis mellifera, but their expression patterns were not identical. Instead, we found B. terrestris to exhibit a novel pattern, whereby most genes upregulated (i.e. showing relatively higher levels of expression) in queen-destined larvae early in development were upregulated in worker-destined larvae late in development. Overall, our results suggest that caste determination in B. terrestris involves a difference not so much in the identity of genes expressed by queen- and worker-destined larvae, but primarily in the relative timing of their expression. This conclusion is of potential importance in the further study of phenotypic diversification via differential gene expression. [ABSTRACT FROM AUTHOR]

The acutely painful scrotum is a common urologic emergency. The primary objective of management is to avoid testicular loss. This requires a high index of clinical suspicion and prompt surgical intervention. In our series conducted between January 1996 and December 2005, 119 patients (age range: 4–62 years) underwent emergency operative exploration for acute scrotal pain. The most common finding was torted cyst of Morgagni (63/119, 52.9%), followed by testicular torsion (41/119, 34.4%). The majority of testicular torsions occurred in the pubertal group (22/41, 53.6%). Only one patient in this group had an unsalvageable testis necessitating orchidectomy, a testicular loss rate in torsion of 2.4%. There were no postoperative wound infections or scrotal haematomas. Testicular salvage depends critically on early surgical intervention, so the delay incurred in diagnostic imaging may extend the period of ischaemia. Furthermore, all radiological investigations have a certain false-negative rate. We advocate immediate surgical exploration of the acute scrotum. We report a low orchidectomy rate (2.4%) in testicular torsion.

This study aimed to analyse and contrast changes in health-related quality of life (HR-QoL) and hand symptoms in the first 6 months after surgical treatment for primary cubital tunnel syndrome. Data originated from the United Kingdom Hand Registry. HR-QoL was assessed using the generic EuroQol five-dimensional assessment tool (EQ-5D-5L) and hand symptoms using the Patient Evaluation Measure (PEM). In total, 281 patients were included in the statistical analysis. Cubital tunnel release resulted in clinically relevant relief of hand symptoms. However, no improvement in HR-QoL was detected by the EQ-5D-5L. As a result, current health economic models, such as those used by the National Institute for Health Care Excellence (NICE) in the UK, might conclude that cubital tunnel release is not cost-effective. This discrepancy requires exploration, and hand-specific preference-based measures might be needed for value-based healthcare in hand surgery. Level of evidence: III., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

Introduction  GABA (γ-aminobutyric acid) is the major inhibitory neurotransmitter in the brain. In response to injury within the central nervous system, GABA promotes cortical plasticity and represents a potential pharmacological target to improve functional recovery. However, it is unclear how GABA changes in the brain after traumatic brachial plexus injuries (tBPIs) which represents the rationale for this pilot study. Methods  We serially scanned seven males (mean age 42 years [SD 19] without head injury) up to 19 months after tBPIs. T1-weighted images (1-mm isotropic resolution) and J-edited spectra (MEscher-GArwood Point RESolved Spectroscopy [MEGA-PRESS], TE 68 ms, TR 2,000 ms, 2 cm isotropic voxels) were acquired using a MAGNETOM Prisma 3T (Siemens Healthcare, Erlangen, Germany). Data were analyzed in jMRUI blind to clinical information to quantify GABA, creatine plus phosphocreatine (Cr), and N-acetylaspartate (NAA) concentrations. Additionally, gray matter and white matter proportions were assessed using SPECTRIM software. Interhemispheric means were compared using linear methods. Confidence intervals (CIs) were generated to the 95% level. Results  Within weeks of injury, the hemisphere representing the injured upper limb had a significantly lower GABA:NAA ratio (mean difference 0.23 [CI 0.06-0.40]) and GABA:Cr ratio (mean difference 0.75 [CI 0.24-1.25]) than the uninjured side. There were no interhemispheric differences in NAA:Cr. By 12 months post-injury, interhemispheric differences in metabolite concentrations equalized. There was no difference in the proportion of gray matter, white matter, or cerebrospinal fluid between the injured and uninjured hemispheres. Conclusion  After brachial plexus injuries, there are interhemispheric differences in GABA concentrations within the sensory and motor cortex. This represents a potential pharmacological target that warrants further investigation., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

Objectives: To determine the diagnostic accuracy of MRI for diagnosing nerve injury in brachial plexus birth injury (BPBI)., Methods: Electronic databases were searched from inception to February 15, 2023 for studies reporting the accuracy of MRI (index test) compared to surgical exploration (reference standard) in detecting the target conditions of: root avulsion, any nerve abnormality, and pseudomeningocele (as a marker of root avulsion) in children with BPBI. Meta-analysis using a bivariate model was performed where data allowed., Results: Eight studies met the inclusion criteria. In total, 116 children with BPBI were included. All included studies were at risk of bias. The mean sensitivity and mean specificity of MRI for detecting root avulsion was 68% (95% CI: 55%, 79%) and 89% (95% CI: 78%, 95%), respectively. Pseudomeningocele was not a reliable marker of avulsion. Data were too sparse to determine the diagnostic accuracy of MRI for any nerve abnormality., Conclusions: At present, surgical exploration should remain as the diagnostic modality of choice for BPBI due to the modest diagnostic accuracy of MRI in detecting root avulsion. The diagnostic accuracy of MRI needs to be close to 100% as the results may determine whether a child undergoes invasive surgery., Advances in Knowledge: Previous research regarding MRI in detecting BPBI is highly variable and prior to our study the overall diagnostic accuracy was unclear. Through conducting a systematic review and meta-analysis, we were able to reliably determine the overall sensitivity and specificity of MRI for detecting root avulsion., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology.)

Aims: The aims of this study were to describe the epidemiology of metacarpal shaft fractures (MSFs), assess variation in treatment and complications following standard care, document hospital resource use, and explore factors associated with treatment modality., Methods: A multicentre, cross-sectional retrospective study of MSFs at six centres in the UK. We collected and analyzed healthcare records, operative notes, and radiographs of adults presenting within ten days of a MSF affecting the second to fifth metacarpal between 1 August 2016 and 31 July 2017. Total emergency department (ED) attendances were used to estimate prevalence., Results: A total of 793 patients (75% male, 25% female) with 897 MSFs were included, comprising 0.1% of 837,212 ED attendances. The annual incidence of MSF was 40 per 100,000. The median age was 27 years (IQR 21 to 41); the highest incidence was in men aged 16 to 24 years. Transverse fractures were the most common. Over 80% of all fractures were treated non-surgically, with variation across centres. Overall, 12 types of non-surgical and six types of surgical treatment were used. Fracture pattern, complexity, displacement, and age determined choice of treatment. Patients who were treated surgically required more radiographs and longer radiological and outpatient follow-up, and were more likely to be referred for therapy. Complications occurred in 5% of patients (39/793). Most patients attended planned follow-up, with 20% (160/783) failing to attend at least one or more clinic appointments., Conclusion: MSFs are common hand injuries among young, working (economically active) men, but there is considerable heterogeneity in treatment, rehabilitation, and resource use. They are a burden on healthcare resources and society, thus further research is needed to optimize treatment., Competing Interests: The British Society for Surgery of the Hand provided funding for the development of research into hand surgery, which covered R. Taha's salary and her costs while working on this study as part of her PhD. R. Taha's doctoral research fellowship was also funded by the National Institute for Health and Care Research (grant number NIHR300197). R. Taha is also on the BSSH's LION Project Leadership Committee. A. Karantana and A. Montgomery report payments to the University of Nottingham from the NIHR towards this study, as well as various contracts for other research. A. Karantana also reports an infrastructure grant from the British Orthopaedic Association to the Nottingham Clinical Trials Unit to support the development of orthopaedic trials, and holds unpaid positions as Chair of the BSSH Research Committee, BOA Subspecialty Research Lead for Hand Surgery, and Research Council member of the Scar Free Foundation., (© 2024 Taha et al.)

Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or sensory nerves. To evaluate the severity of nerve injury, surgical exploration remains the gold standard, particularly after iatrogenic injury and major nerve injury from trauma, such as brachial plexus injury. Recently, advances in imaging techniques (ultrasound, magnetic resonance imaging [MRI] and MR neurography) along with multimodality assessment, including electrodiagnostic testing, have allowed us to have a better preoperative understanding of nerve continuity and prediction of nerve health and possible recovery. This article outlines the current and potential roles for clinical assessment, exploratory surgery, electrodiagnostic testing ultrasound and MRI in entrapment neuropathies, inflammatory neuritis and trauma. Emphasis is placed on those modalities that are improving in diagnostic accuracy of nerve assessment before any surgical intervention., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.