Long-term results of digital reconstruction using toe-to-finger transfers

In the period 1987–2002, 147 toe-to-hand transfers were performed in 111 patients. Traumatic amputation was reconstructed by transfer of 131 toes in 101 patients; congenital anomaly was treated in 10 patients by transplantation of 16 toes. In this study, 60 reconstructed hands were evaluated in 59 patients. Patients were divided into 12 groups according to the type of reconstruction. Group A includes patients with thumb reconstruction using the great toe, wrap-around flap, or second toe transfer. Group B involves patients with thumb and second finger reconstruction; group C comprises cases of second and third finger reconstruction. Group D involves patients with claw hand type of reconstruction, group E includes patients with metacarpal hand reconstruction, and finally group F comprises cases with congenital anomalies. Post-transfer total range of motion and sensitivity were measured on transplanted toes. Functional ability was evaluated by the performance of 20 selected activities of daily life. Successful rate of transfer was 94.6% in post-traumatic transplantation and 100% in congenital anomalies reconstruction. The average total range of motion and two-point discrimination sensitivity was 53° and 11 mm, respectively. The best results, judged by grasping ability, were achieved in group B (thumb and second finger reconstruction), group C (second and third finger reconstruction), and, surprisingly, group E (metatarsal hand). Grasping ability was significantly lower in group D (claw hand type of reconstruction) and group F (congenital hand anomalies). The highest patient satisfaction was achieved in cases of thumb and metacarpal hand reconstruction.     

Asthma in US Seniors: Part 2. Treatment. Seeing Through the Glass Darkly

Background

We sought to identify the best evidence for treatment of asthmatic patients aged 65 years or more.

Methods

We used computer-assisted searches to identify randomized, controlled trials for asthma in the elderly that were published in English between 1950 and 2008.

Results

Small trials of an inhaled corticosteroid versus a leukotriene antagonist and an oral beta₂-agonist versus placebo compose the controlled trial data on asthma therapy in seniors. Epidemiologic evidence suggests that the side effects of corticosteroids and beta-agonists may be more common in the elderly than in younger populations.

Conclusion

Seniors with asthma or comorbid conditions that are common in the elderly have been systematically excluded from asthma treatment trials. There is no compelling evidence to demonstrate the superiority of any pharmacologic therapy in these asthmatic patients. Evaluation of response to asthma treatment in clinical trials remains primarily symptom-based when symptoms have been shown to underestimate the severity of disease in seniors.     

Biopipe: a flexible framework for protocol-based bioinformatics analysis

We identify several challenges facing bioinformatics analysis today. Firstly, to fulfill the promise of comparative studies, bioinformatics analysis will need to accommodate different sources of data residing in a federation of databases that, in turn, come in different formats and modes of accessibility. Secondly, the tsunami of data to be handled will require robust systems that enable bioinformatics analysis to be carried out in a parallel fashion. Thirdly, the ever-evolving state of bioinformatics presents new algorithms and paradigms in conducting analysis. This means that any bioinformatics framework must be flexible and generic enough to accommodate such changes. In addition, we identify the need for introducing an explicit protocol-based approach to bioinformatics analysis that will lend rigorousness to the analysis. This makes it easier for experimentation and replication of results by external parties. Biopipe is designed in an effort to meet these goals. It aims to allow researchers to focus on protocol design. At the same time, it is designed to work over a compute farm and thus provides high-throughput performance. A common exchange format that encapsulates the entire protocol in terms of the analysis modules, parameters, and data versions has been developed to provide a powerful way in which to distribute and reproduce results. This will enable researchers to discuss and interpret the data better as the once implicit assumptions are now explicitly defined within the Biopipe framework.     

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Verhandlungen ärztlicher Gesellschaften

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Verhandlungen Ärztlicher Gesellschaften

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