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This prospective cohort study investigated the responsiveness and interpretability of the Disabilities of the Arm, Shoulder and Hand (DASH) and Unité Rhumatologique des Affections de la Main (URAM) outcome measures for assessing recovery after fasciectomy and dermofasciectomy for Dupuytren’s disease. DASH outcome scores at 1 year were significantly better than at 6 weeks, suggesting that recovery is not complete by 6 weeks. Of the 101 patients recruited to the DASH cohort, 71 completed preoperative, 6 week and 1 year postoperative DASH scores; 68 of them completed preoperative and 1 year postoperative DASH scores and an external anchor question. In the URAM cohort, 30/44 completed the preoperative and the 1 year postoperative URAM scores and the anchor question. The DASH score exhibited moderate responsiveness but poor interpretability on receiver operating characteristic curve analysis, such that a minimal important change could not be estimated. The URAM score showed acceptable responsiveness, and an MIC of 10.5 on receiver operating characteristic analysis. Level of evidence: II

This study investigated aspects of the validity and reliability of the 30-item Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and its relationship with the shorter 11-item QuickDASH in patients with Dupuytren’s disease. Seven hundred and fifty-nine DASH questionnaires were studied, covering pre- and postoperative patients undergoing different treatments for Dupuytren’s disease. Items related to pain rose early after treatment before returning to baseline, suggesting that studying pain is relevant during postoperative recovery. Across all 759 sets of responses, the QuickDASH agreed closely with the DASH. In exploratory factor analysis, the DASH was not unidimensional, questioning the validity of the DASH summary score in Dupuytren’s disease. Further validation of existing PROMs for use in Dupuytren’s disease is needed. These data suggest that pain is a relevant symptom to study during postoperative recovery following treatment for Dupuytren’s disease. Level of evidence: III.

Background Gene-modifying trials offer hope for improvement in chronic paediatric disorders, but they may also lead to disappointment and have an adverse emotional effect on families. This study aimed to examine emotional impact on participants in a paediatric exon-skipping trial. Methods Nineteen male children with Duchenne muscular dystrophy (DMD), and their parents, taking part in a dose-ranging study of an i.v. administered morpholino splice-switching oligomer (which can restore the reading frame in DMD and induce dystrophin expression) underwent a psychosocial/psychiatric examination at trial entry. Emotional impact was assessed at trial completion using questionnaires. Results The mean child age was 8.9 years (SD 2.1); 13(68%) were attending mainstream school. Most families were well adjusted psychosocially at trial entry. Post-trial median child emotional impact scores were 5/10 (n= 18), but impact was rated as positive by 6/14 (42%), neutral/mixed by 5 (35%) and negative by 3 (21%). Median post-trial psychosocial/psychiatric change scores in children and parents were minimal. Actual post-trial negative impact was statistically significantly associated with higher expected impact at trial entry, at which time the families of the three children displaying actual negative impact reported higher family stress levels in combination with a variety of other psychosocial risks factors. Conclusions In carefully selected families with low levels of psychosocial stress/distress at trial entry, and with good support from paediatric research units (including psychiatric input when required), genetic trials in progressive disorders such as DMD can have a predominantly positive or neutral emotional impact. Nevertheless, negative impact is reported by a minority of families and possible psychosocial predictors deserving further scrutiny have been identified.

This study reviews the results of Surface Replacement Trapeziometacarpal (SR TMC, Avanta®, San Diego, CA) total joint arthroplasty. Fifty patients (62 joints) were included in the study. Forty-three patients (54 joints) were seen at final follow up. Seven patients (eight joints) were interviewed over the phone. Seven patients were revised to trapeziectomy and ligament reconstruction with tendon interposition, five for aseptic loosening and two for dislocation. At final follow up, the mean Quick DASH score was 30.4 and the Sollerman Score was 77.3. Radiological review of the surviving 55 joints showed subsidence of four trapezial components in asymptomatic patients. Cumulative survival rate was 91% at 3 years. Eighty-five percent of the patients were satisfied with the outcome of their treatment.

The aim of this study was to review the short-term results of joint replacement in the hand, comparing those done as day cases with those done as inpatients. Procedures included trapeziometacarpal, metacarpophalangeal and proximal interphalangeal joint arthroplasties. For day cases a portable laminar flow machine was used, whereas inpatient procedures were carried out in a laminar flow theatre. The postoperative regime was the same in the two groups. The mean follow-up was 12 months. There was no difference in complications, revisions, pain scores and Quick-DASH scores. No early loosening has been detected in any patients at a minimum of 12 months’ follow-up. All patients who had day surgery were satisfied with the care. The results of day case small joint arthroplasty of the hand are similar to those in inpatients.

The present paper deals with the failure analysis of an input shaft of skip drive gearbox, which had failed after 13 months of service against an expected life of 15 years. Evidences suggest that the input shaft has failed by stress corrosion cracking (SCC). After initiation at the keyway edges, the cracks have propagated progressively along the circumference of the fillet. Once the cross section of the shaft reduced below the critical limit, it has failed by sudden torsional overload. Investigation revealed that use of improper steel with high amount of MnS was responsible for the SCC.

Wrist block has been used to provide pain relief for many procedures on the hand and wrist but its role in arthroscopy of the wrist remains unexplored. Chondrotoxicity has been a concern with the intra-articular infiltration of local anaesthetic. We aimed to evaluate and compare the analgesic effect of portal and wrist joint infiltration with a wrist block on the pain experienced by patients after arthroscopy of the wrist. A prospective, randomised, double-blind trial was designed and patients undergoing arthroscopy of the wrist under general anaesthesia as a day case were recruited for the study. Levo-bupivacaine was used for both techniques. The effects were evaluated using a ten-point visual analogue scale, and the use of analgesic agents was also compared. The primary outcomes for statistical analyses were the mean pain scores and the use of analgesia post-operatively. A total of 34 patients (63% females) were recruited to the portal and joint infiltration group and 32 patients (59% males) to the wrist block group. Mean age was 40.8 years in the first group and 39.7 years in the second group (p > 0.05). Both techniques provided effective pain relief in the first hour and 24 hours post-operatively but wrist block gave better pain scores at bedtime on the day of surgery (p = 0.007) and at 24 hours post-operatively (p = 0.006). Wrist block provides better and more reliable analgesia in patients undergoing arthroscopy of the wrist without exposing patients to the risk of chondrotoxicity. Cite this article: Bone Joint J 2015;97-B:1250–6.

Thermo-mechanically treated (TMT) rebars are extensively used for reinforcement of cement concrete. In a large tropical country like India, where transit times are long and moisture levels are high, the rebars get easily rusted leading to a poor appearance. The present paper documents the work done by the authors to alleviate this problem. The work involved phosphate treatment on the surface of TMT rebars in bundle without additional process steps such as degreasing, rinsing and pickling. Rebars were treated in two alternate phosphate solutions one containing nitric acid and another nitric acid free. The phosphate layer obtained on the rebar surface was dense and black in appearances. When treatment was done in phosphate solution containing nitric acid, Zinc phosphate (hopeite) and zinc–iron phosphate (phosphophyllite) compounds formed. On the other hand, zinc phosphate (hopeite) in combination with iron phosphate (ludllamite) compounds formed when surface treatment was done in nitric acid free phosphate solution. The treated rebars were tested for extended exposure in normal atmosphere as well as under high humidity conditions. Also, Salt spray and Tafel study were conducted. In all cases the results were compared with those for untreated bars as control. Surface treatment carried out in nitric acid free phosphate solution showed 3–4 times improved resistance to red rust formation compared to bars treated in phosphate solution containing nitric acid. The bond strength of the rebar with concrete also increased marginally when treated in nitric acid free phosphate solution, whereas it reduced 10–15% for treatment in phosphate solution containing nitric acid.

The results of surgery for Dupuytren’s disease were prospectively assessed to see if there is a correlation between hand function, the degree of deformity and the post-operative result. A total of 42 patients were followed-up for 6 months. The mean flexion deformity was 81° pre-operatively and 32° post-operatively. The mean Sollerman score improved from 71 (out of 80) pre-operatively to 77 post-operatively. There was a significant correlation between the degree of deformity and the Sollerman score, and also between the improvement in deformity after surgery, and the Sollerman score. We conclude that hand function is worsened by increasing deformity in Dupuytren’s disease and improved by correction of the deformity.

Filariasis is major public health hazard particularly in tropical countries like India. The presence of microfilaria using fine needle aspiration cytology has been reported from various sites. However, the presence of the adult gravid filarial worm with a surrounding host response has rarely been reported on breast aspirates. Here, we report a unique case in which aspiration cytology from a breast lump clinically suspicious of fibroadenosis of the breast, showed adult filarial worms with numerous microfilariae and a granulomatous inflammatory host response. The filarial worm appears to be ubiquitous in endemic areas, and the presence of an unexplained granulomatous lesion in breast should prompt a careful consideration of the filarial etiology in our country. Therapy with diethylcarbamazine, albendazole, and antibiotics are sufficient for treatment of this type of lesion.

Food habits, gut pH and six major digestive enzymes of 11 teleost fishes, comprising one species of each of the families of Notopteridae, Channidae, Cichlidae and eight species of endemic and exotic Cyprinidae have been observed. Almost all the enzymes are present in all the fishes irrespective of their food habit. Teleost fishes of confined water (lentic) exhibit little food preference. Absence of any digestive strategy is due to incomplete food niche segregation in this ecosystem. It is suggested that during the evolution of the vertebrate digestive system, fishes of lentic communities exhibited no canalization in digestive strategy due to incomplete food niche segregation and developed plasticity for digestion.

The limits of the spatial resolution achievable on a standard GE Signa 1.5-T imaging machine have been explored by interfacing a 12-cm-diameter local gradient set to such a system. Using a range of purpose-built radio-frequency (RF) coils, 3D gradient echo images with a spatial resolution of 100×100×500 µ have been routinely obtained on the finger. Also produced were 100×200×500 µ, resolution angiograms of the finger detailing submillimeter vessels, with a velocity encoding of 6 cm s−1. High-resolution fat/water suppressed images and isotropic data sets with a resolution of 170 µ are also demonstrated. With regard to the investigation of the mechanics of the human finger, isotropic data sets are desirable if accurate segmentation is to be implemented. A preliminary study illustrating the potential for producing a magnetic-resonance-based computer simulation of the mechanics of the human finger shows the distal interphalangeal joint extended and then in flexion.

Carpal tunnel syndrome (CTS) and trigger finger are known to occur together in association with conditions such as diabetes mellitus, rheumatoid arthritis and hypothyroidism. Although most cases that present to a hand clinic have no obvious predisposing cause, the two conditions often appear together in the same patient. We performed a prospective study of the prevalence of CTS in hospital outpatients presenting with trigger finger. Six hundred and eighty-one patients with CTS, trigger finger or both conditions were recruited prospectively. Diagnosis of both disorders was made on clinical grounds. The study group comprised 551 patients with no obvious predisposing cause. Of 211 patients with trigger finger, 91 (43%) also had CTS. This prevalence is substantially higher than the population prevalence of CTS of approximately 4%. Our data support an association between idiopathic CTS and idiopathic trigger finger and lend support to common pathophysiological factors.

With the ever-increasing demand for real-time video applications, a dedicated and efficient architecture for motion estimation has become a necessity. In this paper, we present an architecture for affine motion estimation which meets the real-time application requirements. The architecture employs a modular memory structure for efficient pipelined parallel implementation of affine motion estimation using the one-dimensional hierarchical search (IDHS) algorithm. Implementation results in terms of the number of clock cycles and PSNR values demonstrate the efficiency of the proposed architecture.

The present paper proposes architecture for quality-adaptive real-time transmission of audio streams over the Internet. A feedback mechanism between the transport layer and the application layer, that ensures the quality adjustment of real-time streams, forms the backbone of this architecture. A rate adaptation protocol, based on the additive increase/multiplicative decrease principle, is the underlying protocol for the transport layer. It has been proved to be TCP-friendly, fair and effective in keeping the network congestion control separate from the application layer. A quality-adaptive layered coder serves to achieve reliability in the application layer.

This paper describes a method to verify a finite state machine by theorem proving. For some instances, inductive reasoning comes in handy to support the proof of verification. In this work the theorem prover itself tries to find out the properties on which induction needs to be applied. A short account of the proof procedure which is based on goal directed backward reasoning is given. A nontrivial example is presented to illustrate the approach. A proof construction algorithm has been provided. >

A backward reasoning approach to verify a digital circuit is described. The proposed proof procedure is an augmentation of inductive reasoning over the states of a finite state machine. The augmentation addresses the issues related to reasoning with both the data and control paths of the circuit. The methodology has been illustrated with a lift controller example. Limitation of this proof approach is also identified.

Intracerebral clysis is a drug delivery technique that depends on convection-enhanced microinfusion to achieve therapeutic drug levels within the brain. In this study, brain tumor-bearing rats were treated with topotecan delivered systemically and by the intracerebral clysis method. Our objective was to determine the efficacy and tissue distribution of topotecan delivered by intracerebral clysis.The C6/Wistar rat glioma model was used after a thymidine incorporation assay determined topotecan sensitivity of C6 cells in vitro. Long-term survival of animals provided objective measurements of efficacy; records of animal weight during treatment and neurological status served to approximate toxicity. Topotecan tissue penetration was measured in samples of ex vivo tumor and surrounding brain tissue with high-pressure liquid chromatography.Dose escalation demonstrated significant sensitivity of C6 glioma cells to topotecan (median lethal dose, 0.19 micromol/L). Eleven of 12 rats bearing established intracerebral C6 glioma and receiving topotecan by intracerebral clysis survived beyond the end point of 120 days; no untreated control or systemically treated animal survived beyond 26 days (n = 18; P0.005). Histopathological assessment of animals demonstrated significant tumor masses in the brains of intraperitoneally treated animals and untreated control animals. In contrast, no residual tumor was found in the brains of intracerebral clysis groups. Animal weights during treatment were markedly reduced by intraperitoneal dosing (n = 6) but not by low-dose intracerebral clysis (32 microg/kg/d for 5 d; n = 6). None of the low-dose intracerebral clysis-treated animals demonstrated neurological toxicity, and one high-dose intracerebral clysis-treated animal (160 microg/kg/d for 2 d; n = 6) died during follow-up. Topotecan was detected well beyond the boundaries of the tumor and even in the contralateral hemisphere in animals treated with intracerebral clysis.Topotecan delivered by the intracerebral clysis method is effective for treatment of brain tumors in the rat glioma model. These studies provide compelling justification for further preclinical testing to formally evaluate toxicity and efficacy with variable dosing schedules.

Introduction Over the past few years antipsychotic medication are increasingly being used for non psychotic illnesses in young people. These have severe side effects and the long term consequences are unknown. Objectives Identify the non psychotic conditions where an antipsychotic medication had been prescribed. Aims A survey was carried out in a community Child and Adolescent Mental Health Service to find the non psychotic conditions where an antipsychotic medication was prescribed and the reason and choice of the medication. Methods 38 young people were identified from the electronic system that did not meet the criteria for a psychotic illness but had at least one DSM IV TR diagnosis of a non psychotic illness where an antipsychotic medication had been prescribed over the previous 6 months. The case notes of these patients were referred to identify; ▪ The reason for prescribing an antipsychotic. ▪ The antipsychotic that has been prescribed. Results • Most common non psychotic condition where an antipsychotic was used was Attention Deficit Hyperactivity Disorder (25). Other conditions were Autism Spectrum disorder (2), Tourette's Disorder (2), Anxiety Disorder (1) and Obsessive Compulsive Disorder (1). • It was mostly used to manage behavioural problems (22). • Most common medication used was Risperidone (20) followed by Aripiprazole (7) and Haloperidol (3). Conclusions Antipsychotic medications are primarily being used to treat behaviour problems in young people who do not have psychotic illness. Further studies required to see if any other non pharmacological intervention may limit its use.

The authors interfaced a 12-cm-diameter local gradient coil with a solenoid radio-frequency coil (2.2-cm internal diameter, 1.4-cm long) to a recalibrated clinical magnetic resonance imaging system. Three-dimensional gradient-echo imaging and phase-contrast angiography were performed on the fingers of five healthy volunteers (four men and one woman, aged 23-33 years). Data sets (256 x 256 x 28) were acquired with spatial resolution of 100 x 100 x 500 microns in 6 minutes 51 seconds. The angiograms clearly delineated blood vessels that were less than 1 mm in diameter.

A 10-year retrospective study was performed in order to determine the incidence, distribution, histological type and behaviour of skin tumours of the hand that were referred to a regional Plastic Surgery unit. 85 patients were studied and 98 malignant or pre-malignant lesions identified. The majority were squamous cell carcinomas in male manual workers. Recurrence after excision was seen only in lesions greater than 1.5 cm in diameter. The overall incidence of squamous cell carcinoma of the hand (requiring surgical excision) was seen to be five cases per million per year. Other skin tumours were rare.

A 34-year-old male manual worker and part-time physical training instructor presented to the orthopaedic department with pain on the outer aspect of his left ankle following a twisting injury. This had been present for about 9-10 months. On examination, there were no visible abnormalities of the foot and ankle. There was pain on forced inversion. Radiographs of the foot and ankle were normal. A diagnosis of sinus tarsi syndrome (STS) was made and the subtalar joint/sinus tarsi were injected with steroid. This had no effect on his symptoms. A magnetic resonance scan was therefore performed. This showed an area of high signal in the OS calcis just below the subtalar joint. Since the diagnosis was still unclear, a computed tomography (CT) scan was requested. This clearly showed a well-defined lesion, 1.5cms below the subtalar joint, with a nidus typical of osteoid osteoma (Fig. 1). Because of the vicinity of the subtalar joint, it was felt that open excision should be avoided as it would lead to subtalar osteoarthrosis in a fit, physically active young man. A CT scan assisted excision and was therefore performed.

Variables associated with recurrent Dupuytren’s disease, or a ‘diathesis’, have been investigated, but those associated with functional outcome and complications are less well studied. Outcomes 1 or 5 years after an aponeurotomy, fasciectomy or dermofasciectomy were assessed by patient interview and examination at five UK centres. A total of 432 procedures were studied. The reoperation rate did not differ at 1 year ( p = 0.396, Chi-square test with Monte Carlo simulation), but was higher after aponeurotomy in the 5-year group (30%, versus 6% after fasciectomy and 0% after dermofasciectomy, p = 0.003, Chi square test with Monte Carlo simulation). Loss of function (DASH>15) did not differ between procedures at 5 years, even when reoperation and other variables were controlled. Diabetes, female gender and previous ipsilateral surgery were associated with poorer function in logistic regression analysis. The variables associated with poor function after treatments differ from diathesis variables. Aponeurotomy had lower complication rates than fasciectomy and dermofasciectomy. This may counterbalance the former’s higher recurrence rate and explain why aponeurotomy demonstrated similar long-term functional outcome compared with excisional surgery in this study. Level of evidence: III