Modified Brunelli pull-out technique in flexor tendon repair for zone II: a study on 58 cases

Background  

The reconstruction of the continuity of flexor tendons disruptions in zone II still remains one of the most challenging problems in hand surgery. The ideal repair has to provide sufficient strength and the possibility of early mobilization in the attempt to obtain a functional range of motion. One of the methods which appears to respond to these requests is the pull-out technique described by Brunelli, which moves the tension from the level of the tendon disruption to the finger pulp over the tendon insertion.     

Transitions in neural oscillations reflect prediction errors generated in audiovisual speech

According to the predictive coding theory, top-down predictions are conveyed by backward connections and prediction errors are propagated forward across the cortical hierarchy. Using MEG in humans, we show that violating multisensory predictions causes a fundamental and qualitative change in both the frequency and spatial distribution of cortical activity. When visual speech input correctly predicted auditory speech signals, a slow delta regime (3-4 Hz) developed in higher-order speech areas. In contrast, when auditory signals invalidated predictions inferred from vision, a low-beta (14-15 Hz) / high-gamma (60-80 Hz) coupling regime appeared locally in a multisensory area (area STS). This frequency shift in oscillatory responses scaled with the degree of audio-visual congruence and was accompanied by increased gamma activity in lower sensory regions. These findings are consistent with the notion that bottom-up prediction errors are communicated in predominantly high (gamma) frequency ranges, whereas top-down predictions are mediated by slower (beta) frequencies.     

Delayed Recovery of Myocardial Blood Flow After Intracoronary Stem Cell Administration

The aim of the present study was to investigate the changes in absolute myocardial blood flow (AMF) after intracoronary injections of mesenchymal SC (MSC) and compared to controls in closed-chest reperfused acute myocardial infarction (AMI) in pigs. Male MSCs, transiently transfected with Luciferase (Luc-MSC) were delivered (9.7 ± 1.2 x 10(6)) intracoronary in the open infarct-related artery one-week post-AMI in female pigs (group MSC), while saline was injected with the same injection rate in controls (group C). The AMF was measured immediately after, and 3, 12 and 24 h post-intracoronary Luc-MSC or saline injections. In vitro bioluminescence images and quantitative real-time TaqMan PCR measurements were performed to quantify the sex-mismatched MSCs. No difference between the groups was observed regarding the weight, heart rate, blood pressure and global ejection fraction 1-week post-AMI. The baseline AMF were similar in the groups (61.3?±?15. vs 61.1?±?12.0 ml/min). AMF was decreased significantly immediately after intracoronary MSC delivery (42.0?±?12.4 vs 57.7?±?15.7 ml/min p?=?0.013), and remained low at 3 h (40.9?±?13.4 vs 55.8?±?4.9 ml/min, p?=?0.004), 12 h (43.0?±?3.7 vs 57.8?±?5.4 ml/min, p?=?0.001) with incomplete recovery at 24 h (47.2?±?5.5 vs 62.1?±?14.1 ml/min, p?=?0.038) as compared to controls, respectively. In vitro bioluminescence displayed transfected Luc-MSCs along the proximal and mid part of the LAD, with limited number (295?±?101 sry copied/million cardiac cells) of Y-chromosome-MSCs in the infarcted area. Intracoronary injection of SCs results in immediate decrease of AMF, with delayed recovery. The delivery of the SC into the injured myocardium might be hindered by the altered coronary pressure and flow conditions.     

A surge of flu-associated adult respiratory distress syndrome in an Austrian tertiary care hospital during the 2009/2010 Influenza A H1N1v pandemic

We report on 17 patients with influenza A H1N1v-associated Adult Respiratory Distress Syndrome who were admitted to the intensive care unit (ICU) between June 11th 2009 and August 10th 2010 (f/m: 8/9; age: median 39 (IQR 29-54) years; SAPS II: 35 (29-48)). Body mass index was 26 (24-35), 24% were overweight and 29% obese. The Charlson Comorbidity Index was 1 (0-2) and all but one patient had comorbid conditions. The median time between onset of the first symptom and admission to the ICU was 5 days (range 0-14). None of the patients had received vaccination against H1N1v. Nine patients received oseltamivir, only two of them within 48 hours of symptom onset. All patients developed severe ARDS (PaO(2)/FiO(2)-Ratio 60 (55-92); lung injury score 3.8 (3.3-4.0)), were mechanically ventilated and on vasopressor support. Fourteen patients received corticosteroids, 7 patients underwent hemofiltration, and 10 patients needed extracorporeal membrane-oxygenation (ECMO; 8 patients veno-venous, 2 patients veno-arterial), three patients Interventional Lung Assist (ILA) and two patients pump driven extracorporeal low-flow CO(2)-elimination (ECCO(2)-R). Seven of 17 patients (41%) died in the ICU (4 patients due to bleeding, 3 patients due to multi-organ failure), while all other patients survived the hospital (59%). ECMO mortality was 50%. The median ICU length-of-stay was 26 (19-44) vs. 21 (17-25) days (survivors vs. nonsurvivors), days on the ventilator were 18 (14-35) vs. 20 (17-24), and ECMO duration was 10 (8-25) vs. 13 (11-16) days, respectively (all p = n.s.). Compared to a control group of 241 adult intensive care unit patients without H1N1v, length of stay in the ICU, rate of mechanical ventilation, days on the ventilator, and TISS 28 scores were significantly higher in patients with H1N1v. The ICU survival tended to be higher in control patients (79 vs. 59%; p = 0.06). Patients with H1N1v admitted to either of our ICUs were young, overproportionally obese and almost all with existing comorbidities. All patients developed severe ARDS, which could only be treated with extracorporeal gas exchange in an unexpectedly high proportion. Patients with H1N1v had more complicated courses compared to control patients.     

Mineralisation patterns in the subchondral bone plate of the humeral head

Purpose  

Pathologic changes of the glenohumeral joint, like a long-standing overloading or an accident often lead to severe glenohumeral osteoarthritis, and a glenohumeral joint replacement could be necessary. Joint instability and glenoid loosening are the most common post-operative complications, which can be caused by eccentric loading of the glenoid, if the humeral head is malcentered. If these malcentered cases could be identified pre-operatively, the pathologic position of the humeral head could be fixed intra-operatively and complication may be prevented. Computed tomography osteoabsorptiometry (CT-OAM) is a useful method to determine the distribution of mineralisation in the subchondral bone as a marker for the long-term loading history of a joint. The objective of this study was to gain information about the mineralisation distribution in the subchondral bone plate of the humeral head.     

In vitro antiplasmodial activity of extracts of Alchornea cordifolia and identification of an active constituent: ellagic acid

Extracts of leaves of Alchornea cordifolia were studied for their antiplasmodial activities. Chloroformic and ether extracts were found to be inactive while the ethanolic extract exhibited mild in vitro activity against Plasmodium falciparum. Fractionation of this extract led us to isolate ellagic acid as the active constituent of the extract with IC(50) in the range of 0.2-0.5 microM. Cytotoxicity of ethanolic fraction and ellagic acid was also estimated on human fibroblasts cells (IC(50) on Hela cells = 7.3 microM at 24 h for ellagic acid).