Laparoscopy for Small Bowel Obstruction Caused by Single Adhesive Band

Methods:A total of 62 patients were enrolled. The OT group underwent laparoscopy (n = 16), and the CT group (n = 46) did not. We compared early and late outcomes between the 2 groups.Results:Times to first flatus, oral intake, and defecation after treatment were shorter in the OT group (P = .030, .033, and .024), and the recurrence rate was lower in the OT group than in the CT group (6.2% vs 32.6%; P = .038). Time from discharge to first recurrence was longer in the OT group than in the CT group (172 vs 104.6 ± 26.5 days, P = .027).Conclusions:SBO related to a single adhesive band is not effectively treated by CT. However, laparoscopic OT provides notable success if the surgery is performed early. Therefore, it should be the preferred treatment.     

Biomechanical analysis of tension band wiring (TBW) of transverse fractures of patella

Purpose: Tension band wiring is commonly used for fixation of simple transverse fractures. The popular configuration is parallel Kirschner wires (K-wires) and a stainless steel wire loop placed in a vertically oriented figure-of-8. Methods: We used a wooden model of a patella with a midway transverse fracture and compared four different types of fixation. The first construct had a vertical figure-of-8 with one twist of wire. The second contained a vertical figure-of-8 with two twists of wire. The third was a vertical figure-of-8 with two twists of wire placed at adjacent corners while the last one had a horizontal figure-of-8 with two twists of wire placed at adjacent corners. Interfragmentary compression at the point of wire breakage was measured for each construct as well as permanent displacement on cyclic loading. Results: Placement of the figure-of-eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% (p < 0.05, Tukey post hoc test). On cyclic loading, all the constructs with vertical figure-of-eight but none with a horizontal construct failed (p ¼ 0.01; Fisher''s exact test). Permanent fracture displacement after cyclic loading was 67% lower with horizontal figureof-eight constructs (p < 0.05; t test). Conclusion: Placing wire twists at the corner and a horizontal placement of figure-of-8 improves stability of the construct.     

Experiences with pins and rubber band traction in the treatment of proximal interphalangeal joint contracture

BACKGROUND:

Proximal interphalangeal joint (PIPJ) contracture is a difficult problem to treat regardless of etiology. Although numerous interventions have been recommended, published results are mediocre at best.

OBJECTIVE:

The authors describe their experience and results of using a modification of pins and rubber band traction (PRBT) – applying a dynamic extension apparatus to a contracted PIPJ using the constant traction force in a stretched rubber (elastic) band.

METHOD:

A retrospective review of patients treated with this method was performed, and the results are presented. The technique itself is described, and clinical photographs illustrate the method.

RESULTS:

Mean PIPJ flexion contracture before PRBT was 82° (range 60° to 110°). The full correction of eight contracted PIPJs in seven patients was achieved, in a mean of 17.8 days (range 14 to 31 days). At one month postremoval of PRBT, the mean PIPJ flexion contracture was 22.8° (range 0° to 46°).

DISCUSSION:

The method is compared with previously described methods of PIPJ contracture correction, whether surgical or splinting; the latter may be static, dynamic or a combination of the two. The results of previously published studies are discussed and compared with the method described.

CONCLUSION:

The present method is a powerful and effective simplification of a previously described method of correcting PIPJ contractures. This technique is simple, ‘low-tech’ and can be applied under local anesthetic; the authors believe it offers a useful adjunct to surgical release.     

AO张力带技术用于髌骨不同部位骨折内固定的生物力学研究

目的通过生物力学实验来研究AO张力带技术用于髌骨不同部位骨折内固定的力学稳定性,从而为髌骨骨折的治疗提供理论依据。方法取8具新鲜成人尸体膝关节,于髌骨中点、髌骨上下1/3及1/4用线锯将髌骨做成横行骨折模型,按AO张力带技术采用克氏针加钢丝固定建成实验力学模型,对股四头肌进行加载测试,加载负荷以骨折端分离1mm为实验终点,记录加载的力、髌骨骨折端分离的位移,并进行统计学分析。结果根据髌骨骨折端分离位移1mm为失效的约定,在1/2部位AO张力带能达到最大的张力为（452.2±15.1）N;在上1/3部位AO张力带能达到最大的张力为（361.2±12.3）N;在下1/3部位AO张力带能达到最大的张力为（351.0±5.6）N;在上1/4部位AO张力带能达到最大的张力为（226.7±5.8）N;在下1/4部位AO张力带能达到最大的张力为（215.3±13.1）N。结论按照正常人单膝关节生理负荷为350～400N计算,在髌骨1/2及1/3横行骨折AO张力带技术均能达到人体的生理载荷,在1/4部位则不能达到人体的生理载荷。     

Force transients and minimum cross-bridge models in muscular contraction

Two- and three-state cross-bridge models are considered and examined with respect to their ability to predict three distinct phases of the force transients that occur in response to step change in muscle fiber length. Particular attention is paid to satisfying the Le Chatelier-Brown Principle. This analysis shows that the two-state model can account for phases 1 and 2 of a force transient, but is barely adequate to account for phase 3 (delayed force) unless a stretch results in a sudden increase in the number of cross-bridges in the detached state. The three-state model (A-->B-->C-->A) makes it possible to account for all three phases if we assume that the A-->B transition is fast (corresponding to phase 2), the B-->A transition is of intermediate speed (corresponding to phase 3), and the C-->A transition is slow; in such a scenario, states A and C can support or generate force (high force states) but state B cannot (detached, or low-force state). This model involves at least one ratchet mechanism. In this model, force can be generated by either of two transitions: B-->A or B-->C. To determine which of these is the major force-generating step that consumes ATP and transduces energy, we examine the effects of ATP, ADP, and phosphate (Pi) on force transients. In doing so, we demonstrate that the fast transition (phase 2) is associated with the nucleotide-binding step, and that the intermediate-speed transition (phase 3) is associated with the Pi-release step. To account for all the effects of ligands, it is necessary to expand the three-state model into a six-state model that includes three ligand-bound states. The slowest phase of a force transient (phase 4) cannot be explained by any of the models described unless an additional mechanism is introduced. Here we suggest a role of series compliance to account for this phase, and propose a model that correlates the slowest step of the cross-bridge cycle (transition C-->A) to: phase 4 of step analysis, the rate constant k(tr) of the quick-release and restretch experiment, and the rate constant k(act) for force development time course following Ca(2+) activation.     

Predictive performance of obesity indexes for the risk of high blood pressure in an adult population

Background and objectives

Comparisons of predictive performance of various anthropometric measures in high blood pressure have not been investigated. This study aimed at evaluating and comparing the predictive power of Body Mass Index (BMI), Body Adiposity index (BAI) and A Body Shape Index (ABSI) for predicting hypertension in adults.

Stereotyped topography of different elevated contingent negative variation components in children with migraine without aura points towards a subcortical dysfunction

Increased negativity during contingent negative variation (CNV) is thought to reflect abnormal neural activation in adult migraineurs' attention related processing. Findings in childhood and adolescence have yielded less clear results. This study characterizes the age-dependent development of CNV topography in migraine during childhood in order to elucidate the origin and cerebral generators of described CNV elevations. A large sample of children with primary headache (migraine with/without aura, tension type headache) and healthy controls aged 6-18 years was examined in a CNV paradigm using 64-channel high resolution DC-EEG. Patients were tested for diagnose-related topographic group differences of initial CNV (iCNV), late CNV (lCNV) and postimperative negative variation (PINV). All three CNV components of 6-11-year-old migraineurs without aura showed elevated negativity over the supplementary motor area (SMA) and around the vertex. Migraine children lacked age-dependent development of late CNV around Cz as previously reported. However, they showed a normal development of late CNV over pre-/primary motor cortex (MI). There was no marked elevation of iCNV amplitude over frontal areas (orienting reaction) nor specific amplitude elevations over "motor" or "sensory" areas during sustained attention (late CNV). Additional "pre-mature" activation e.g., in the locus coeruleus (leading to diffuse cortical activation summing up to a maximum over the vertex) or the basal ganglia (interacting with SMA) explained the rather stereotyped CNV elevation around the vertex better than a specific implication of the cortical systems responsible for orienting, motor preparation or sensory attention.