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Abstract Background Ulnar nerve entrapment at the elbow is the second most common cause of nerve entrapment in the upper limb. Surgical techniques mainly include simple decompression, decompression with anterior transposition and medial epicondylectomy. Methods We performed decompression with anterior transposition and protected ulnar nerve by adipofascial flap (a random flap with radial based vascularization, harvested through the avascular plane of Scarpa’s fascia. We analyzed patients who underwent ulnar nerve ante-position from 2015 to 2022 according to inclusion and exclusion criteria for a total of 57 patients. All patients included were graded on the McGowan's classification Messina criteria and the British Medical Research Council modified by Mackinnon and Dellon. Results The average McGowan’s score was 2.4 (± 0.6), Messina’s criteria 91.2% indicated a satisfactory or excellent result, sensibility at 6 months was 98.5% S3 or more. A preferential technique has not yet been defined. Conclusions The adipofascial flap offers numerous advantages in providing a pliable, vascular fat envelope, which mimics the natural fatty environment of peripheral nerves and creates favorable micro-environmental conditions to contribute to neural regeneration via axon outgrowth.

Osteoid osteoma is a benign bone tumor that usually grows in the long bones of the body and arises from osteoblasts and some components of osteoclasts. It represents the third most frequent type of benign bone tumors, accounting for 11% to 14% of the tumors. The entity usually involves the proximal femur and tibia. It has also been reported in the hand, especially the scaphoid, capitate, and proximal phalanx. The most common symptom is pain, usually during the night, relieved by the use of salicylates and nonsteroidal anti-inflammatory drugs. To date, only 5 cases involving the trapezium have been reported. This article describes a rare case of a large (1.3 cm) osteoid osteoma of the trapezium in a young male patient treated surgically with resection and curettage of the osteoid and provides a review of the existing literature.

Complex trauma of the upper limb is a common consequence of involvement in serious accidents. Loss of substance including nerve, bone, tendons and vascular defects are challenging surgical issues. A 27- year-old male presented with complex upper limb trauma and loss of a proximal third of the posterior forearm structure as well as loss of active finger extension, ulnar and radial nerve territory anesthesia and ulnar fracture. A composite nerve-tendon-muscle-skin gracilis free flap was retrieved from the contralateral leg, related to tendon transfer of BR to ELP, to supply active hand extension. The patient was required to adhere to intensive post-surgical rehabilitation and monitored for a 3-year follow-up period. Our assessment revealed adequate skin trophism and sufficient muscle strength recovery against resistance (M5). The functional flap associated with tendon transfer was considered an efficient procedure for the management of a complex trauma with loss of posterior interosseous nerve and bone exposition. The free re-innervated gracilis flap may be used to repair complex soft tissue defects with exposed bone and to restore finger extension following severe forearm injuries.

In this paper I will talk about relationship between music, sound and allegory. This report implies reflection on the “linguistic nature” of music. I will examine the concept of allegory in the example of Salvatore Sciarrinos’ Allegoria della notte (1985) where “musical” and “extra-musical” dimensions come in. Nell’articolo si riflette sul rapporto tra musica, suono e allegoria, riflessione che implica anche quella sulla “natura linguistica” della musica. In particolare, viene presa ad esempio la Allegoria della notte (1985) di Salvatore Sciarrino, dove entrano in gioco le dimensioni del “musicale” e dell’“extramusicale”.

Abstract Background Distal Phalanx (DP) fractures are the most common hand injuries. Bone fixation associated with soft tissue reconstruction, is often required to ensure more effective outcomes. The aim of the present study is to compare functional outcomes of DP fractures surgically treated with crossed manual drilled 23 Gauge needles vs crossed Kirschner-wires (k-wire). Methods Clinical data included analysis of patient demographics, range of motion (ROM), and complications. Radiographic assessment considered fracture type, location, fracture displacement, and radiographic union. Functional outcomes analysis was performed.The statistical significance was assessed at the level of probability lower than 5%. Results A total of 60 patients from 2012 to 2015 were retrospectively enrolled and among them 12 patients suffering from diabetes or current smokers. A total of 60 DP fractures were treated, 32 with needles (group A) and 28 with k-wire fixation (group B). Time to union, showed in different time points, was significantly lower in group A (≤ 40 days, p = 0.023*) compared to group B. ROM of the distal interphalangeal joint at six months follow-up was 60° in group A and 40° in group B. A significant improvement was observed (p = 0.001*) in the 23 G needle treated group. Functional outcome analysis showed that VAS was significantly lower in group A compared to group B (p = 0.023*). Conclusion Our study showed that the 23 G needle yielded satisfactory results in terms of time to union and range of motion compared to k-wire fixation especially for tuft and shaft DP fractures. Therefore, should be a valid alternative to k-wire fixation in selected patients.

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.

The Green Edge initiative was developed to investigate the processes controlling the primary productivity and fate of organic matter produced during the Arctic phytoplankton spring bloom (PSB) and to determine its role in the ecosystem. Two field campaigns were conducted in 2015 and 2016 at an ice camp located on landfast sea ice southeast of Qikiqtarjuaq Island in Baffin Bay (67.4797∘ N, 63.7895∘ W). During both expeditions, a large suite of physical, chemical and biological variables was measured beneath a consolidated sea-ice cover from the surface to the bottom (at 360 m depth) to better understand the factors driving the PSB. Key variables, such as conservative temperature, absolute salinity, radiance, irradiance, nutrient concentrations, chlorophyll a concentration, bacteria, phytoplankton and zooplankton abundance and taxonomy, and carbon stocks and fluxes were routinely measured at the ice camp. Meteorological and snow-relevant variables were also monitored. Here, we present the results of a joint effort to tidy and standardize the collected datasets, which will facilitate their reuse in other Arctic studies. The dataset is available at https://doi.org/10.17882/59892 (Massicotte et al., 2019a).

Background and Objectives: Tendon injury and tendinopathy are among the most frequent musculoskeletal diseases and represent a challenging issue for surgeons as well as a great socio-economic global burden. Despite the current treatments available, either surgical or conservative, the tendon healing process is often suboptimal and impaired. This is due to the inherent scarce ability of tendon tissue to repair and return itself to the original structure. Recently, Adipose-derived mesenchymal stem cells (ADSC) and stromal vascular fraction (SVF) have gained a central interest in the scientific community, demonstrating their effectiveness in treatments of acute and chronic tendon disorders in animals and humans. Either enzymatic or mechanical procedures to obtain ADSC and SVF have been described and used in current clinical practice. However, no unified protocols and processes have been established. Materials and Methods: This systematic review aims at providing a comprehensive update of the literature on the clinical application of ADSC enzymatically or mechanically processed to obtain SVF, alone and in association with biomaterials in the local treatment of tendinopathy and tendon injury in vivo, in animal models and humans. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Thirty-two articles met our inclusion criteria, with a total of 18 studies in animals, 10 studies in humans and 4 studies concerning the application of biomaterials in vivo in animals. The review of the literature suggests that ADSC/SVF therapy can represent a promising alternative in tendonregenerative medicine for the enhancement of tendon healing. Conclusions: Nevertheless, further investigations and randomized control trials are needed to improve the knowledge, standardize the procedures and extend the consensus on their use for such applications.

A considerable amount of evidence supports the value of teaching physical education (PE) and the Common Core in unison. This study investigated mathematics concepts taught during fitness segments in elementary PE. Specifically, we studied student perceptions about linking PE activities and mathematics. We wanted to determine if math concepts could be added to the fitness portion of elementary PE classes without a reduction in the amount of physical activity performed, and if student absorption of mathematics knowledge increased by combining the two fields. Fifty-five upper elementary-age students (8-12 years old) of various ethnic backgrounds from one school in Arizona participated. They wore pedometers and also completed mathematics worksheets preintervention and postintervention. Results showed that 54 of 55 students had extremely positive perceptions, indicating their enjoyment of mathematics as a part of the fitness activity. The students completed the math problems during the fitness segment, with a significant increase in mathematics knowledge. We did not find significant differences between step counts in the regular fitness and mathematics fitness segments. The students enjoyed the mental challenge of mathematics content while being physically active in the fitness segment of the class.

L’eco di un fantasma (2017) by Azio Corghi went on stage at Teatro Lirico in Cagliari on November 3, 2018. It is a “lyric tragedy” on text by Maddalena Mazzocut-Mis and the subject is inspired by Euripides’ Trojans. I will examine the main characteristics of the composition among the concepts of opera and tragedy.

L’articolo prende in esame l’azione riformatrice di Lutero in ambito musicale, con particolare attenzione al rapporto tra fede e sentimento. Avviata con la riorganizzazione in chiave tedesca della messa latina, e diversamente dalla liturgia romana, che affidava ad un coro le lodi a Dio, l’azione di Lutero ha dato vita ad una pratica corale in lingua tedesca, ad un canto devozionale, fuori e dentro la liturgia, quale espressione diretta della fede del popolo. Da un punto di vista strettamente musicale, il canto devozionale luterano, comunemente nella forma del corale o, meglio, prima di Bach del semplice Lied, nasce sulle forme ed i testi del preesistente canto gregoriano. Tanto pervasiva è stata la rivoluzione musicale di Lutero che si può parlare a buon diritto di gregoriano tedesco, contrassegno sì della moderna nazione tedesca, ma anche di una profonda lacerazione nel cuore del cristianesimo. Alla fine del Settecento, sarà questo uno dei rimproveri che Novalis muoverà a Lutero. The article examines Luther’s action to reform the field of music. Particular attention is paid to the relationship between faith and feeling. Through reorganization of latin mass, unlike the Roman liturgy which entrusted to a chorus of praise to God, the action of Luther gave birth to a choral practice now in German. Outside and inside the liturgy, the singing was direct expression of the faith of the people. Strictly on the musical plan, the Lutheran devotional song, the choral or better Lied, born on the forms and the texts of pre-existing Gregorian chant. So pervasive was Luther’s musical revolution that we can rightly speak of German Gregorian, the mark of modern German nation, but also of a deep laceration inside Christianity. At the end of the XVIIIth century, this will be one of the reproaches that Novalis will move to Luther. Der Aufsatz untersucht die Wirkung von Luthers Reformation im Bereich der Musik, mit besonderem Augenmerk auf der Beziehung zwischen Glaube und Gefühl. Angefangen mit der deutschen und damit von der römischen Liturgie abweichenden Reorganisation der lateinischen Messe, hat Luther eine deutschsprachige chorale Praxis ins Leben gerufen, sprich: einen inner- wie außerhalb der Liturgie als direkten Ausdruck des Volksglaubens betrachteten frommen Gesang. Vom streng musikalischen Gesichtspunkt aus gründet dieser Gesang, gleichermaßen in der choralen Form wie, vor Bach, als einfaches „Lied“, auf den vorgängigen Formen und Texten des gregorianischen Gesangs. Die von Luther ausgehende musikalische Revolution ist so durchdringend gewesen, dass man mit gutem Recht von einer „deutschen Gregorianik“ sprechen kann, die ebenso sehr die moderne deutschen Nation kennzeichnet wie die tief gehenden Verwerfungen im Herzen des Christentums selbst. Am Ende des 18. Jh. wird dies einer der Vorwürfe sein, die Novalis gegen Luther erhebt.

Peritendinous adhesions are a frequent occurrence following tenolysis and present a major clinical challenge regarding prevention and management, with no recovery assured from conservative or surgical approaches. Herein, we investigated the effectiveness of Hyaloglide®, a hyaluronan gel-based product with a novel autocross-linked technology, in a rabbit model affected by tenolysis on the flexor digitorum communis tendon (FDC). A 1.5-cm-long scrubbing of the tendon surface was performed bilaterally to induce peritendinous adhesion on FDC of 30 animals with subsequent application of Hyaloglide® on the surrounding injured area, in one randomly chosen tendon. The contralateral tendon was treated with saline solution as the control. We sacrificed the rabbit models after 45 days of surgery and quantitatively assessed the generation of peritendinous adherence and regeneration of the tendon sheaths using histological (hematossyline-eosine, masson’s trichromic), histomorphometrical (Tang score, Soslowsky Svesson, and Cook score), light electron microscopic, and gene expression investigations. Four rabbits were devoted to biomechanical analysis. Peritendinous adhesions were limited in Hyaloglide®-treated tendons; moreover, well-regenerated tendon sheaths were observed conversely to untreated tendons presenting with extensive areas of adhesions on the tendon surface. Histomorphometrical analysis revealed an adhesion score (Tang score) significantly better in the treated group (p = 0.001 *) compared to the control group. Moreover, the Soslowsky, Svensson, and Cook score parameters revealed a significantly improved regeneration for fiber structure, cellularity, and vascularity in the treated group (p = 0.001 *). No differences were reported for cartilaginous formation (p = 0.08). Gene expression analysis showed a significant increase in collagen type I expression in the treated group compared to the control group, while metalloprotease 1 and 9 were significantly increased in the control group. Biomechanical analysis did not show significant differences in both groups. Hyaloglide® treatment was safe and well-tolerated, generating improved tissue status. Local application of Hyaloglide® prevents adhesion formation after tenolysis and promotes normal healing with regeneration of the synovial sheath in a rabbit model.

Abstract Background In recent times, anti-cancer treatments have focused on Fibroblast Growth Factor (FGF) and Vascular-Endothelial Growth Factor (VEGF) pathway inhibitors so as to target tumor angiogenesis and cellular proliferation. One such drug is Nintedanib; the present study evaluated the effectiveness of Nintedanib treatment against in vitro proliferation of human prostate cancer (PCa) cell lines, and growth and progression of different grades of PCa lesions in pre-clinical PCa transgenic adenocarcinoma for the mouse prostate (TRAMP) model. Methods Both androgen-independent (LNCaP) and androgen-dependent (PC3) PCa cell lines were treated with a range of Nintedanib doses for 72 h, and effect on cell growth and expression of angiogenesis associated VEGF receptors was analyzed. In pre-clinical efficacy evaluation, male TRAMP mice starting at 8 and 12 weeks of age were orally-fed with vehicle control (10% Tween 20) or Nintedanib (10 mg/Kg/day in vehicle control) for 4 weeks, and sacrificed immediately after 4 weeks of drug treatment or sacrificed 6–10 weeks after stopping drug treatments. At the end of treatment schedule, mice were sacrificed and ventral lobe of prostate was excised along with essential metabolic organ liver, and subjected to histopathological and extensive molecular evaluations. Results The total cell number decreased by 56–80% in LNCaP and 45–93% in PC3 cells after 72 h of Nintedanib treatment at 2.5–25 μM concentrations. In pre-clinical TRAMP studies, Nintedanib led to a delay in tumor progression in all treatment groups; the effect was more pronounced when treatment was given at the beginning of the glandular lesion development and continued till study end. A decreased microvessel density and VEGF immunolocalization was observed, besides decreased expression of Androgen Receptor (AR), VEGFR-1 and FGFR-3 in some of the treated groups. No changes were observed in the histological liver analysis. Conclusions Nintedanib treatment was able to significantly decrease the growth of PCa cell lines and also delay growth and progression of PCa lesions to higher grades of malignancy (without inducing any hepatotoxic effects) in TRAMP mice. Furthermore, it was observed that Nintedanib intervention is more effective when administered during the early stages of neoplastic development, although the drug is capable of reducing cell proliferation even after treatment interruption.

Background and objectives: Complex limb traumas are commonly treated with microsurgical reconstruction and free flaps. However, complications are frequent in patients affected by a previous trauma or comorbidity, atheromasia and a single valid vessel. Free flap reconstruction is indeed a challenging procedure in complex injuries, which may increase the risk of limb ischemia. The Arteriovenous loop (AVL) technique may be considered an efficient alternative treatment. We herein report our procedure and previous research regarding the AVL method using a two-step reconstruction in cases of complex high-energy limb injuries. Materials and Methods: In this single center retrospective cohort study, all the patients from 2014 to 2018 who underwent to AVL reconstruction were assessed. A total of six patients were included in the study for traumatic limb trauma. The two-stage technique was performed each time. The age and sex of patient, the time between stage one and two, the length of AVL loop and rate of free flap success were evaluated. Results: A total of seven AVL reconstructions were performed. The mean age of patients was 36 years old. Eight free flaps were performed; six free flaps were transferred to the vascular loops. The average time between stage one and two was 13 days. The mean length of the pedicle was 25 cm for the upper limb and 33.7 cm for the lower limb. All the free flaps successfully take root. In one case, a surgical revision was required the second day post-operatory due to venous congestion. Conclusions: AVL is a useful and safe technique in microsurgical reconstruction which will prevent vascular complications. Our investigations suggest the efficacy and feasibility of a two-step intervention in acute post-traumatic events. A single-step procedure should be preferred in chronic situation and oncologic reconstruction.

Background and objectives: Complex limb wounds with multiple tissue involvement are commonly due to high energy trauma. Tissue damage is a dynamic entity and the exact extent of the injury is rarely instantly perceptible. Hence, reconstruction frequently involves a multi-stage procedure concluding with tissue replacement. Materials and Methods: A retrospective study was conducted between 2006 and 2018 and included 179 patients with contaminated multi-tissue injuries treated with hyperbaric oxygen therapy, negative pressure therapy, physiotherapy and drug treatment associated with multiple surgical time in a multistep approach, focusing on pain levels and wound closure rates. Results: Despite the long-term response to traumatic events, a combined approach of delayed surgical reconstructive time in mangled upper limb yielded satisfactory functional outcomes. Conclusions: The complex upper limb wound with deep tissue exposure may be treated with a multi-stage procedure alternatively to immediate reconstruction. The integrated technique enables the preservation of existing healthy tissue and concurrent radical debridement, reducing the risk of infection, as well as avoiding the loss of free flaps and dehiscence due to incorrect wound estimation.

Today, teachers complain about the lack of physical education time and the lack of physical education programming. In addition, a great deal of time is spent advocating the relationship between "healthy mind-healthy body." Today's drive to show a relationship between physical fitness/activity and academic achievement is really not different than that advocated by Dr. Dudley Sargent, a pioneer of physical education, over a hundred years ago. So the "takeaway" is that physical education beliefs have remained strikingly similar throughout the history of American physical education. The author argues that to make schools active and healthy requires making a lot of small changes. It is time to keep positive practices and supplement them with new ideas, instruction, and models. Physical activity and health must be used as outcomes for program accountability. It is time to stop pursuing fitness and skill development as accountability measures. After 60 years of demonstrating a lack of improvement and even declining health among students and adults, the author asserts that these are unachievable outcomes. In this paper, the author discusses the ever-changing face of physical education and explores how the profession has changed its focus of curriculum, instruction and accountability over the past 150 years with regular moves from one trend to the next. He suggests that teachers refocus their professional outcomes and measure behaviors and knowledge that really matter. He points out that teachers teach fitness and skills as instructional outcomes and use activity and healthy eating as "authentic assessment outcomes" that are achievable.

There have been limited prospective studies investigating physical activity and physical self-perceptions in children. In this investigation, mean steps/day did not significantly change from late elementary to junior high for either boys or girls; however, boys accumulated more steps both at baseline and follow-up. Physical self-perception measures were significantly related to changes in steps/day and accounted for 21% (15% adjusted) of the variance after controlling for demographic/biological variables, R[superscript 2] change = 0.21, adjusted R[superscript 2] change = 0.15, F(5, 88) = 4.66, p less than 0.001. Sport competence emerged as the most important predictor, t(88) = -3.76, p less than 0.001, and was inversely related to physical activity change. The lack of opportunities to participate in sport activities normally found at the onset of adolescence may help explain this unexpected result. (Contains 5 tables and 1 figure.)

Limited data are available on the contributory and compensatory relationships between physical education and physical activity in children. Four hundred eighty-five (280 girls) children in first through sixth grades wore sealed pedometers during waking hours, including normally scheduled physical education lessons. The least, moderately, and most active children accumulated approximately 1,700, 1,100, and 2,500 more steps/day, respectively, on school days with physical education. No compensatory increases in physical activity were found on school days that did not offer physical education. The implications of the contributory relationship are highlighted by the evidence that 50% of the least active children were at risk for overweight or overweight and that no compensatory increases in physical activity were found on school days when physical education classes were not scheduled. (Contains 4 figures.)

Increasing motivation towards physical activity through quality physical education has recently gained considerable attention. Several investigators have outlined specific models or theories to illustrate how motivation can be enhanced in physical education. Enhancing a youngster's perceived physical competence, promoting intrinsic motivation through the basic tenets of self-determination theory, and creating a motivationally adaptive climate based on a mastery goal orientation have all been advanced as possible strategies to increase motivation for physical activity. This article demonstrates how these approaches can be effectively integrated in physical education to increase the likelihood of motivating all individuals to become, and remain, physically active. Specific strategies that can be used to increase students' motivation towards physical activity are also provided. (Contains 3 tables.)

When young teachers stand in front of their classes for the first time, they are expected to be well prepared for the challenging task before them. Unfortunately, preparations for this moment rarely include lessons on the essential skill of "teacher talk"--the choice and use of words in a class. This skill is often overlooked in teacher preparation courses, perhaps because it is assumed that teacher talk is a natural skill that one either does or does not possess. However, new teachers can benefit greatly from a systematic approach to learning and mastering effective teacher talk. This article explores the need for effective teacher talk and provides specific examples of speech patterns that will help new and experienced teachers alike.

Assessment and evaluation of children's physical fitness should be an educational process. This process is described as the "personalized self-testing" approach. This approach is a form of self-assessment that teaches children to assess their personal level of health-related physical fitness, interpret the results, and use the information (with the teachers help) to develop personal fitness goals. Fitness self-assessment attempts to minimize or eliminate experiences that are negative and comparative, while making fitness assessment student centered, personalized, and educational. In this article, the authors discuss the benefits of the "personalized self-testing approach" and strategies to put it into action. (Contains 3 figures.)

Physical education means many things to many people. Physical education professionals often describe it as essential subject matter dedicated to learning in the psychomotor domain and committed to developing lifetime physical activity patterns. However, some individuals mistakenly consider physical education to be the same as athletics or competitive sports. Some perceive physical education to be recess or free-time play. Suffice it to say that while some view it as a meaningful subject matter area, others report having less than satisfactory physical education experiences, if they had physical education at all. In this article, the author talks about physical education as a necessary component of the total school curriculum. He argues that strong physical education program must place emphasis on helping all youngsters succeed, regardless of ability or skill level. He contends that physical education experiences should be designed and planned to meet the needs of these less able students. (Contains 1 figure.)

Analyzed the amount of activity, intensity of activity, and attitudes of participants in Czech high school physical education classes taught using different teaching styles and dance forms. Measurements of heart rate and dance intensity and student surveys indicated that teaching style and dance form significantly impacted the intensity and volume of activity. Teaching style had less impact than dance form. (SM)