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Background: Distal radius fractures (DRF) are the most common upper extremity fractures in adults. The purpose of this study was to determine the incidence, causes, and independent predictors for unplanned return to the operating room (URTO) in a single institution within 90 days following distal radius open reduction internal fixation (ORIF). Methods: A retrospective study of 2933 consecutive patients from January 2015 to December 2019 who underwent distal radius ORIF was undertaken. Patients who returned to the operating room within 90 days of the index procedure were identified. Patients with planned return to the operating room for staged procedures were excluded, yielding a patient cohort of those with URTO. Demographic data, causes for reoperation, and final Quick Disabilities of the Arm, Shoulder and Hand DASH (QuickDASH) scores were collected. Results: Overall, 45 patients had URTO (1.5%) occurring a mean of 44 (6-89) days from the index procedure. Reasons for reoperation included nerve complications (n = 14), loss of fixation (n = 11), hardware complications (n = 9), wound complications (n = 7), and tendon complications (n = 4). Neurologic reasons for return included carpal tunnel release (n = 13) and ulnar nerve decompression (n = 1). QuickDASH scores were higher for URTO compared with control cohort at the final follow-up (33 [range: 0-91] vs 14 [range: 0-100], P < .01). Conclusions: Mechanical hardware failure and neurologic symptoms were the most common reasons for URTO after distal fracture ORIF.

BACKGROUND: Duplex ultrasound (DU) is used in the diagnosis of neurogenic thoracic outlet syndrome (NTOS) to measure compression of the subclavian artery (SCA) which is thought to strengthen the NTOS diagnosis. However, the value of DU in NTOS remains unclear.METHODS: A retrospective review of a prospectively acquired database from the TOS center of the Catharina Hospital Eindhoven was performed of patients referred between January 2017 and December 2019. Only "proven NTOS" patients, defined as a successful response to thoracic outlet decompression (TOD) surgery based on patient-reported outcomes (NRS pain scale, CBSQ and DASH score) were included to exclude wrongfully diagnosed NTOS patient. The presence of vascular symptoms (defined as discoloration, edema or temperature changes of the hand or fingers), results of provocative maneuvers, and outcome of DU was used for analysis. To assess the link between vascular symptoms and compression on DU, a chi-squared test was performed. Further, we looked for a correlation between vascular symptoms, compression on DU and clinical outcome using a repeated measures analysis of variance (ANOVA).RESULTS: Vascular symptoms were seen in 49 of 133 patients (36.8%). In total, 51 of 133 patients (38.3%) had at least 50% variation in SCA peak systolic velocity (PSV) during DU at the level of SCA stenosis. SCA occlusion was seen in 11 patients (8.3%) during provocative maneuvers. The presence of clinical "arterial symptoms" was not significantly correlated with vascular laboratory findings, neither for alterations in PSV during DU (P = 0.245) nor for positional SCA occlusion (P = 0.540). No statistically significant correlations between the degree of SCA stenosis and postoperative outcomes, as measured with the DASH, CBSQ, or NRS scale for pain were found (P = 0.787).CONCLUSIONS: The role of DU in the work-up of NTOS in patients with vascular complaints is questionable. Changes in flow velocities are seen in NTOS patients and do not correlate with "vascular symptoms" or clinical outcome.

Background Achieving medial support for proximal humeral fractures (PHFs) by regular calcar screw positioning is challenging when the humeral head is small or locking plates are placed distally, as there are unable inserted calcar screws into the humeral head. We aimed to investigate the suitability of the two strategies, slotting calcar screw (SCS) and off-axis calcar screw (OCS) to achieve medial support for PHFs. Methods Regular calcar screw (RCS), SCS, OCS, and non-calcar screw (NCS) were tested via mechanical experiments and finite element analysis (FEA), using synthetic bones for biomechanical comparisons. All PHFs treated in our hospital from March 2017 to March 2019 were reviewed. The patients were divided into three groups based on the calcar screw fixation: RCS, SCS, and OCS. The postoperative varus collapse (neck-shaft angle changed to less than 120°) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were recorded. Results The properties of RCS, SCS, and OCS against the torsion and varus force were superior to those of NCS, while the stiffness of SCS, OCS, and RCS were similar. FEA predicted lower peri-screw strains in the OCS and SCS than in the RCS, indicating a lower risk of cut-out. Patients (n = 125; 75 female, 50 male) aged 55.9 ± 13.0 years were evaluated. Compared with the RCS (5/55), varus collapse incidences were not significantly higher following SCS (0/29, p = 0.094) or OCS (3/41, p = 0.756), and neither were DASH scores (p = 0.867 and 0.736, respectively). Conclusions This study is a preliminary study demonstrating that the SCS and OCS fixation strategies could be useful alternatives when regular calcar fixation is not possible using the plate at hand.

Background: The Dietary Approach to Stop Hypertension (DASH) eating pattern has been recommended as a healthy dietary plan by several international guidelines. However, data on the association between the DASH diet and breast cancer (BC) is limited. This study investigated the association between the DASH dietary pattern and risk of BC.Methods: This is a hospital-based case-control study conducted between 2014 and 2016 in the Cancer Institute of Iran. Patients with histopathologically confirmed BC were recruited. Controls were healthy subjects who were frequency matched to cases by residential place and age (±10years). A validated 168-item Food Frequency Questionnaire (FFQ) was applied to assess the dietary intake of participants. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ). The DASH dietary pattern scores were calculated using the method introduced by Fung. Unconditional logistic regression, in which potential confounders were taken into account, was applied to determine the association between adherence to the DASH dietary pattern and odds of BC. Results: The study participants comprised 477 patients with BC and 507 healthy controls. In the total population, patients with BC were slightly older (45.9 vs. 43.9 y, P=0.02), had slightly higher BMI (21.9 vs. 20.2, P=0.01) and were less physically active (20 vs. 27 MET h/wk. Ptrend =0.004). Even after controlling for more cofounders, greatest adherence to DASH diet was associated with a 34% reduction in risk of BC (OR 0.66; 95% CI 0.46, 0.94; Ptrend=0.03). In premenopausal women, adherence to the DASH dietary pattern was insignificantly associated with a 32% reduction in BC risk. This risk reduction was 38% in postmenopausal women, which was also not found to be significant Conclusion: Adherence to the DASH dietary pattern could be associated with an approximately 30% reduction in risk of BC. However, further studies, in particular studies with prospective design, are required to confirm this claim.

Functioning is an important outcome for the management of rheumatoid arthritis (RA). Heterogeneity of respective patient-reported outcome measures (PROMs) challenges direct comparisons between their results. This study aimed to standardize reporting of such PROMs measuring functioning in RA to facilitate comparability.Common-item nonequivalent group design with the Health Assessment Questionnaire (HAQ) as a common scale across data sets from various countries (including the UK, Turkey, and Germany) to establish a common metric was used. Other PROMs included are the physical function items of the Multidimensional HAQ (MDHAQ), the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the World Health Organization Disability Assessment Schedule II (WHODAS II), the Medical Outcomes Study Short Form 36 (SF-36) health survey, and 4 short forms (20, 10, 6, and 4 physical function items) from the Patient-Reported Outcomes Measurement Information System. As the HAQ includes mobility, self-care, and domestic life items, this study focuses on these 3 domains. PROMs were described using standard error of measurement (SEM) and smallest detectable difference (SDD). A Rasch measurement model was used to create the common metric.The range of the SEM was 0.2 (MDHAQ) to 7.4 (SF-36 health survey physical functioning domain). The SDD revealed a range from 9.7% (WOMAC rating scale) to 33.5% (WHODAS physical functioning domain). PROMs co-calibration revealed fit to the Rasch measurement model. A transformation table was developed to allow exchange between PROM scores.Scores between the daily activity PROMs commonly used in RA can now be compared. Factors such as SEM and SDD help to determine the choice of a PROM in clinical practice and research.

Purpose The purpose of this study was to investigate outcomes following arthroscopic elbow contracture release to describe the use of arthroscopy for improvement in extension/flexion and pronation/supination arcs of motion at a single institution for degenerative and posttraumatic etiologies. Methods Consecutive arthroscopic elbow arthrolysis performed between 2003 and 2015 were retrospectively reviewed. Basic patient demographics, indications for surgery, preoperative and postoperative elbow range of motion, postoperative patient outcome score, and all complications were recorded and analyzed. Results Fifty-two patients were included with an average follow-up of 5.1 years (range 1.4 to 9.4). Severe contractures made up 50% of cases, followed by 23% moderate, and 27% mild. Average extension/flexion for the post-traumatic group (n = 30) increased by 63° ± 31 and by 29° ± 24 for the degenerative group (n = 22). Average gain in pronosupination was 38° ± 62 in the post-traumatic group and 13°±23 in the degenerative group. Postoperative DASH scores were 17.5 ± 18.4 for post-traumatic cases and 12.8 ± 19.3 for degenerative cases. Conclusion Arthroscopic elbow contracture release is an effective intervention for degenerative and post-traumatic elbow contracture for both flexion/extension and pronosupination contracture. Furthermore, a two-stage release should be considered when both flexion and pronosupinaton contractures are present. Level of Evidence IV, case series, treatment study

Background The scapular osseous free flap (SOFF) has become an important reconstructive option for complex head and neck defects. Postoperative donor site function is, however, an important consideration. The objective of this study was to prospectively investigate SOFF donor site morbidity and to relate the findings to hand dominance and neck dissection. Methods Objective assessment included bilateral measurement of shoulder, elbow, and hand range of motion (ROM), hand strength, and distal nerve function in consecutive patients with head and neck cancer SOFF reconstruction at a tertiary referral center in Sweden between 2016 and 2019. The subjective function was assessed by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Results Sixteen of 20 consecutive patients were evaluated (median follow-up 10 months [range 3–17]). Significant side differences in shoulder range of motion (ROM) (flexion, abduction, external and internal rotation) were observed for patients where the SOFF had been harvested from the same side as their dominant hand (n = 9; Ps ≤ 0.04). For patients where the SOFF was harvested from the non-dominant hand side, no significant shoulder ROM side differences were observed (n = 7; Ps ≥ 0.08). There were significant side differences in shoulder ROM for patients who underwent neck dissections (n = 12; Ps ≤ 0.03), not for the other four patients. Patients reported low but varying DASH scores (median 2.5, range 0–57). Conclusion Postoperative donor site morbidity seems to be quite acceptable after SOFF surgery. The results indicate possible benefits of choosing the non-dominant hand side for the SOFF and that a neck dissection affects postoperative shoulder outcome. Further studies are however needed.

Незадовільні результати лікування у пацієнтів старше 60 років з переломами дистального метаепіфіза променевої кістки зустрічаються в 44 % випадків (не вдається отримати задовільного зіставлення відламків після первинної репозиції або настає вторинне зміщення). Переважна більшість пацієнтів лікується консервативно за рядом об’єктивних причин. Великий відсоток поганих результатів обумовлює пошук оптимальної методики ведення таких пацієнтів. Мета: оптимізувати тактику надання амбулаторно-поліклінічної допомоги постраждалим із переломами дистального метаепіфіза променевої кістки шляхом мультимодального знеболення, малотравматичної репозиції за допомогою запропонованого пристрою і фіксації фрагментів адекватними засобами іммобілізації з використанням нових технологій, що дозволить поліпшити результати лікування. Матеріали та методи. При надходженні пацієнтам із переломом дистального метаепіфіза променевої кістки проводили щадну репозицію з застосуванням запропонованого пристрою пластирного витягнення, фіксації сучасними пластиковими фіксуючими пов’язками скотчкаст. У всіх 12 пацієнтів визначали компоненти болю. Проведення профілактичних заходів (психогенна підготовка постраждалих, мультимодальне знеболювання, медикаментозна профілактика та лікування, раннє фізіолікування і лікувальна фізкультура) призвело до зниження вираженості больового синдрому. Вже до 4-ї доби після травми постраждалі відзначали зниження інтенсивності болю з 7,42 ± 0,31 бала до 2,40 ± 0,12 бала на 7-му і 14-ту добу за даними візуально-аналогової шкали (задовільна переносимість болю — 2,1 ± 0,1 бала і 2,2 ± 0,3 бала, що є свідченням доброї переносимості болю). Такі ж показники збереглися і до кінця іммобілізаційного періоду. Результати лікування оцінювали через 90 днів після травми. Після відновного лікування 11 пацієнтів оцінювали біль як незначну і терпиму. У 1 постраждалого мала місце хронізація больового синдрому (5,2 ± 0,6 бала). Були контрактури пальців і променезап’ясткового суглоба. Зберігався нейропатичний виражений больовий синдром. У 2 пацієнтів мали місце виражені нейротрофічні та функціональні порушення, які в подальшому потребували тривалого консервативного лікування. При опитуванні хворих за шкалою DASH функцію пошкодженої руки визначили як задовільну (33,2 ± 0,4 бала). Отримані нами результати свідчать про ефективність запропонованого підходу до лікування пацієнтів із переломами дистального метаепіфіза променевої кістки.

\ud Background and aims\ud Hypertension is among the major risk factors for cardiovascular events in the Iranian population. This cross-sectional study was designed to examine the association of adherence to the dietary approaches to stop hypertension (DASH) and Mediterranean (MED) dietary patterns with the distribution of blood pressure and pre-hypertension prevalence.\ud \ud Methods and results\ud This cross-sectional study was carried out in 1363 non-hypertensive adults. Adherence to the DASH and MED diets was calculated using a semi-quantitative food frequency questionnaire (FFQ). Hypertension was measured by the standard method. Multiple logistic regression was applied to obtain the odds ratio of pre-hypertension in the tertiles of MED and DASH dietary patterns. Compared to the lowest, participants with the highest adherence to the DASH dietary pattern had significantly lower systolic blood pressure (SBP) (111.3 ± 11.8 vs. 112.8 ± 12.5; P = 0.010) and diastolic blood pressure (DBP) (70.7 ± 9.2 vs. 71.8 ± 9.8; 0.042). There was no significant difference in the mean SBP and DBP among the participants across tertiles of MED or diet adherence. Higher scores of the DASH and MED diets were inversely associated with lower SBP after adjustment for all potential confounders (OR = −0.04, 95% CI = −0.29, −0.01, P = 0.039) and (OR = −0.04, 95% CI = −0.72, −0.02, P = 0.044), respectively. Also, DASH and MED dietary patterns was associated with reduced OR of pre-hypertension occurrence by 13% (OR: 0.87; 95% CI: 0.70–0.98; P for trend = 0.042) and 16% ([OR: 0.84; 95% CI: 0.69–0.97; P trend = 0.035), respectively.\ud \ud Conclusion\ud Adherence to the DASH and MED diets was inversely associated with the odds for pre-hypertension and SBP.

Paleoclimate data assimilation (DA) is a novel tool for reconstructing past climates that directly integrates proxy records with climate model output. Despite the potential for DA to expand the scope of quantitative paleoclimatology, these methods remain difficult to implement in practice due to the multi-faceted requirements and data handling necessary for DA reconstructions, the diversity of DA methods, and the need for computationally efficient algorithms. Here, we present DASH, a MATLAB toolbox designed to facilitate paleoclimate DA analyses. DASH provides command line and scripting tools that implement common tasks in DA workflows. The toolbox is highly modular and is not built around any specific analysis, and thus DASH supports paleoclimate DA for a wide variety of time periods, spatial regions, proxy networks, and algorithms. DASH includes tools for integrating and cataloguing data stored in disparate formats, building state vector ensembles, and running proxy (system) forward models. The toolbox also provides optimized algorithms for implementing ensemble Kalman filters, particle filters, and optimal sensor analyses with variable and modular parameters. This paper reviews the key components of the DASH toolbox and presents examples illustrating DASH's use for paleoclimate DA applications.

Background: Concerns about test administration, reliability estimations, content and internal structure (dimensionality) of available shoulder measures for people with proximal humeral facture led to the development of a new clinician-observed outcome measure: the Shoulder Function Index (SFInX). The SFInX measures shoulder function by judgement of actual ability to perform daily tasks in which the shoulder is involved. Patients and health professionals had input into the instrument development, and Rasch analysis was used to create a unidimensional, interval-level scale. This study comprehensively evaluated the measurement properties of the SFInX in people recovering from a proximal humeral fracture. Methods: Data were collected on 92 people [79 women, mean age 63.5 years (SD13.9)] who sustained a proximal humeral fracture within the previous year on three occasions to allow for evaluation of the following measurement properties: construct validity (convergent, discriminant and known-groups validity), longitudinal validity (responsiveness), intra-rater reliability (one week retest interval), and inter-rater reliability (n = 20 subgroup; two independent raters). Comparative measures were Constant Score and Disabilities of the Arm Shoulder and Hand (DASH) and discriminative measure was a mental status questionnaire. Minimal clinically important difference, floor and ceiling effects and feasibility of the SFInX were also evaluated. A priori hypotheses were formulated where applicable. Results: Results for construct validity testing supported hypothesised relationships (convergent validity r = 0.75-0.89 (Constant Score and DASH); discriminant validity r = -0.08 (mental status); known-groups validity r = 0.50). For longitudinal validity, lower correlations (r = 0.40-0.49) than hypothesised (r = 0.50-0.70) were found. The SFInX scores changed more (10.3 points) than other scales, which could indicate that the SFInX is more responsive than the comparative measures. Intra-rater and inter-rater reliability found ICCs of 0.96 (95 % CI 0.94-0.97) and 0.91 (95 % CI 0.63-0.97) respectively, with low measurement error (SEM = 3.9-5.8/100). A change of 11-12 points (out of 100) was indicative of a clinically important difference. Conclusions: The SFInX is a feasible outcome measure which clinicians can use to reliably measure and detect clinically important changes in the construct of 'shoulder function', the ability to perform activities in which the shoulder is involved, in people recovering from a proximal humeral fracture.

Māszinības Veselības aprūpe Nursing Studies Health Care Darba mērķis: Noskaidrot, vai pastāv korelācija (kāda sakritība), starp vizuālas un audiālas izglītošanas metodi, atkarībā no ģimenes ārstu prakses, māsu darba stāža. Darba uzdevumi: 1. Noskaidrot, cik procentuāli daudz ģimenes ārstu māsas, kuru darba stāžs ir mazāks par 5 gadiem, pacientus labāk izvēlās izglītot ar audiāli uztverošu informāciju; 2. Noskaidrot, cik procentuāli daudz ģimenes ārstu māsas, kuru darba stāžs ir lielāks par 5 gadiem, pacientus labāk izvēlās izglītot ar audiāli uztverošu informāciju; 3. Noskaidrot, cik procentuāli daudz ģimenes ārstu māsas, kuru darba stāžs ir mazāks par 5 gadiem, pacientus labāk izvēlās izglītot ar vizuāli uztverošu informāciju; 4. Noskaidrot, cik procentuāli daudz ģimenes ārstu māsas, kuru darba stāžs ir lielāks par 5 gadiem, pacientus labāk izvēlās izglītot ar vizuāli uztverošu informāciju; 5. Salīdzināt ģimenes ārstu māsu izglītošanas metodžu korelāciju hroniskiem nieru vai sirds mazspējas pacientiem par uztura ierobežojumiem. Datu analīzes metodes:aprakstošā statistika, kur iegūtie dati tiks apkopoti grafikos un tabulās. Salīdzināšanas tests – t-kritērijs, kā arī Pīrsona korelācijas koeficients. Darba hipotēze: Pieaugot ģimenes ārstu prakses māsu darba stāžam, ģimenes ārstu prakses māsas izvēlās pacientus izglītot vairāk audiāli nekā vizuāli. Atslēgas vārdi: hroniska sirds mazspēja, hroniska nieru mazspēja, pacientu izglītošana, DASH, vidusjūras diēta, minerālvielas, fosfors, nātrijs, kalcijs, kālijs. Darba struktūra: ievads, teorētiskā daļa, kurā ir 6 nodaļas un 9 apakšnodaļas, praktiskā daļa, kurā ir - nodaļa, secinājumi, literatūras avotu saraksts. Darbs satur 22 lpp., 33 literatūras avotus. Sasniegtie rezultāti un secinājumi: 1. Lielākajai daļai respondentu galvenais, kvalitatīvas izglītošanas faktors ir laika trūkums. 2. Respondenti ar lielāku darba stāžu jūtas pārliecinātāki par savām izglītošanas prasmēm, kā arī izmanto izglītošanas procesā vairāk literatūru, kas ir balstīta uz zinātniskiem pētījumiem. 3. Abu respondentu grupas pārsvarā pacientus izglīto audiāli, taču respondenti ar lielāku darba stāžu to dara procentuāli nedaudz mazāk, nekā respondenti, kuru darba stāžš ir mazāks par pieciem gadiem. 4. Abas respondentu grupas nejūtas pilnībā pārliecinātas par to, ka pacientus vajadzētu izglītot vairāk vizuāli nekā audiāli, jo to piekopj ikdienā. 5. Hipotēze neapstiprinājās, jo lai arī dati, attiecībā uz izglītošanas veidu bija ļoti līdzīgi, respondentiem ar darba stāžu virs 5 gadiem, izglītošana ar vizuālām metodēm bija salīdzinoši izplatītāka izglītošanas metode The purpose of the work: To find out whether there is a correlation (a certain coincidence) between the visual and audio education method, depending on the practice of family doctors, the seniority of nurses. Work tasks: 1. To find out what percentage of family physician nurses with less than 5 years of experience prefer to educate patients with audial perceptive information; 2. To find out what percentage of family doctor nurses with more than 5 years of experience prefer to educate the patient with audial perceptive information; 3. To find out what percentage of family physician nurses with less than 5 years of experience prefer to educate the patient with visually perceptive information; 4. To find out what percentage of family physician nurses with more than 5 years of experience prefer to educate the patient with visually perceptive information; 5. To compare the correlation of methods of education of nurses of family doctors for chronic kidney or heart failure patients about nutritional restrictions. Methods of data analysis: descriptive statistics, where the obtained data will be summarized in graphics and tables. Comparison tests – t-test, as well as Pearson's correlation coefficient. Work hypothesis: As nurses increase in seniority, nurses choose to educate patients more audial than visually. Keywords: chronic heart failure, chronic renal failure, patient education, DASH, Mediterranean diet, minerals, phosphorus, sodium, calcium, potassium. Work structure: introduction, the theoretical part, consisting of 6 chapter and 9 suledivisions, practical part with - chapter, conclusions, list of literature sources. The work contains 22 pages, 33 source of literature. Achieved results and conclusions: 1. For the majority of respondents, the main factor of quality education is lack of time. 2. Respondents with longer working experience feel more confident about their teaching skills, and also use more literature in the teaching process that is based on scientific research. 3. The groups of both respondents mostly educate patients with audio methods, but respondents with more work experience do it in percentage slightly less than respondents with less than five years of work experience. 4. Both groups of respondents do not feel completely convinced that patients should be educated more visually than with audio method, as it is practiced on a daily basis. 5. The hypothesis was not confirmed, because although the data regarding the type of education were very similar, for respondents with more than 5 years of work experience, education with visual methods was a relatively more common method of education

Background Total wrist fusion (TWF) is indicated for longstanding degenerative, posttraumatic and/or post-oncological conditions to provide pain relief and wrist stability at partial expense of wrist motion. Patients and Methods A total of 11 consecutive patients who had completed TWF with Vascularized Fibula Graft (VFG) for massive distal radius defects were identified retrospectively from our centre using inpatient records. We evaluated bone fusion times and long term functional outcomes following the procedure. Post-operative grip strength (GS) and prono-supination were objectively measured. The new Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to rate disability and symptoms; pre- and post- operative pain with the Visual Analog Scale (VAS) was assessed. A literature review of the present studies about TWF with VFG was performed, with the aim of comparing long-term functional results of the surgical techniques so far reported in the English literature. Results Our experience with TWF using VFG appeared slightly better than that found in the literature. The procedure was successful in all the cases, achieving bone union in 4,8 months on average. Complication rate was 27,2%, no flap loss was recorded. There were no wrist instability, deformation or dislocation; mean pronation/supination (P/S) was 57,5°/61,2°. Average grip strength resulted 59% of the contralateral side. Mean recorded levels of visual analog scale (VAS) for pain postoperatively were 2,32 ± 0,792, which improved significantly from the pre-operatively value of 7,90 ± 0,79. Mean overall satisfaction was good and all the patients comfortably returned to normal activities. Conclusions Wrist arthrodesis by means of VFG resulted to be an effective and reliable option in dealing with massive defects of distal radius with involvement of radio-carpal joint. Although the cohort analyzed is relatively small and definitive conclusions cannot be drawn, the long term radiographs and the overall functional outcomes encourage to use the described surgical option over other techniques, such as prosthetic replacement and non-vascularized bone grafts.

Background: Shoulder pain is one of the most commonly reported musculoskeletal problems after low back pain. One common reason for the shoulder pain is supraspinatus tendinitis that is often associated with impingement syndrome. Objective: To find the effects of kinesio taping in reducing pain and disability in subjects with supraspinatus tendinitis. Methodology: In this study, patients were randomly allocated the treatment using a set of predefined inclusion and exclusion criteria. Subjects were managed with kinesio taping. Pre- and post-evaluation of the patients was done using Numerical Pain Rating Scale (NPRS) and Disability of Arm Shoulder & Hand Questionnaire (DASH) score and the data gathered was entered and analyzed using SPSS version 23. Results: Mean difference of 2.65 was reported between the pretreatment and post treatment values of NPRS in KT taping group which was significant (P < 0.05). Mean difference of 27.25 was reported between the pre-treatment and post-treatment values of DASH score in KT taping group which was significant (P < 0.05). Conclusion: Kinesio taping is an effective Program in management of supraspinatus tendinitis.

Objectives We examined the relationship between the Japanese version of Patient-Rated Elbow Evaluation (PREE-J) and other established subjective and objective outcome measures in Japanese patients with rheumatoid arthritis (RA) who underwent total elbow arthroplasty (TEA). Materials and Methods This study involved 46 elbows of 40 RA patients. We collected clinical data 1 year after surgery, including the PREE-J, the Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder, and Hand (DASH), and Hand20. The correlation and responsiveness to PREE-J were evaluated compared with other outcome measures preoperatively and postoperatively. Results Almost all outcome measures were improved significantly after surgery. Preoperative PREE-J was significantly correlated with preoperative DASH, Hand20, and MEPS. Interestingly, postoperative PREE-J did not correlate with postoperative MEPS. Multiple regression analyses revealed that preoperative grip strength [B = −0.09; 95% confidence interval (95% CI) −0.17 to −0.01, p = 0.03] and preoperative Hand20 (B = 0.31, 95% CI 0.03–0.58, p = 0.03) were significant factors that might influence the postoperative PREE-J. Conclusions The PREE-J was shown to correlate well with other preoperative outcome measures among the RA patients included in the current study. The postoperative PREE-J after TEA was influenced by the preoperative grip strength and function of the hand.

BACKGROUND Thoracodorsal artery perforator (TDAP) flap and muscle-sparing latissimus dorsi (MSLD) flap have been frequently used for axillary coverage after hidradenitis suppurativa (HS) excision. However, none showed superiority to others. This study compared both flaps to define the ideal option, highlighting flap outcomes and functional and aesthetic results. METHODS A retrospective study was conducted to compare both flaps that were used for axillary reconstruction in nine patients with bilateral HS Hurley stage III between 2017 and 2020. Eight TDAP and 10 MSLD flaps underwent functional evaluation using shoulder abduction angle (SA); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS) for pain; and the Dermatology Life Quality Index (DLQI) questionnaires. Aesthetic assessment included the Scar Cosmesis Assessment and Rating (SCAR) scale and arm-chest interval. RESULTS The mean operating time was 194.4 ± 51.58 and 128.5 ± 31.45 min for TDAP and MSLD (p = .009), respectively. Flap complications were significantly higher in the TDAP group (p = .034). There was no significant difference between both groups regarding SA; DASH, DLQI, VAS, and SCAR scale (p > .05). The mean arm-chest interval was significantly longer in the MSLD than in the TDAP group by 6.9 mm (p = .001). CONCLUSIONS TDAP and MSLD are comparable versatile flaps to eradicate axillary HS with higher TDAP flap complications. Although the TDAP flap is less bulky than the MSLD flap, the MSLD flap shortens the harvesting time without a significant difference in functional outcomes and scar results.

BACKGROUND Adult traumatic brachial plexus injuries (BPIs) can result in severe impairment following penetrating wounds, falls, and motor vehicle accidents or other high-energy trauma. OBJECTIVE Quantify functional outcomes of adult patients with a BPI using a myoelectric orthosis to restore elbow flexion. STUDY DESIGN Retrospective review. METHODS A clinic specializing in the BPI treatment at a large academic medical center tested nineteen adult patients with BPI. These patients had failed to achieve antigravity elbow flexion following their injury and observation or surgical reconstruction. They were provided a myoelectric elbow orthosis (MEO) if they had detectable electromyography signals. RESULTS There was significant improvement in strength and significant reductions in function and pain when using an MEO. Following initiation of the MEO, 12 of the 19 patients had clinical improvements in muscle strength, 15 patients showed improvement in their DASH, and 13 patients reported improvements in their Visual Analog Scale. CONCLUSION The use of an MEO improves elbow flexion strength, increases function, and reduces pain in the majority of patients with BPI and inadequate elbow flexion following observation or surgical reconstruction.

Background: Patient-reported outcome measures are largely used in clinical practice and scientific community. Michigan hand questionnaire (MHQ) is widely recognized as a standardized reliable instrument for the assessment of any kind of hand disorders. Aim of the study: translation, cross-cultural adaptation and validation of the Italian version of MHQ. Methods: The study was composed by two phases. Phase 1 consisted in translation and cross-cultural adaptation of MHQ, from original language version (English) into Italian, according to the standard procedure of translation and back translation. The final Italian version of MHQ was tested on 136 Italian patients with hand disorders (Phase 2), in addition to Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Visual analogue scale (VAS) for pain assessment and grip strength, to psychometric properties of the new version, 55 patients repeated the questionnaire after 7 days for test-retest to assess the reproducibility of the questionnaire. All data were subsequently analyzed (descriptive statistics, multitrait analysis, reliability and construct validity assessment). Results: Phase 1 was performed without major problems, thus the final Italian version was approved for Phase 2. The questionnaire was clear and easily understood (missing data 0–2.9%). Multitrait analysis brought very good results for each outcome measure. High reliability (Cronbach’s alpha: 0.91–0.99) and very good reproducibility (Intraclass correlation coefficients: 0.83–0.98) were revealed. High to moderate correlation was found between MHQ and DASH, grip strength and VAS. Conclusions: The Italian version of MHQ has demonstrated to be reliable and valid.

Assuming that some patients may benefit from early supervised rehabilitation after distal radial fractures, we investigated to what extent self-reported measures of disability, pain and performance of daily activities 2 weeks after anterior locking plating of distal radial fractures could predict long-lasting disability. We included 101 patients in a prediction study and recorded the scores of the Disability of the Arm, Shoulder and Hand questionnaire, visual analogue scales for pain and the Canadian Occupational Performance Measure. We found that the Disability of the Arm, Shoulder and Hand scores with a cut-off score of 50 were the best at predicting disability at 6 months in patients who did not receive early supervised therapy. The positive predictive value was 65% and the negative predictive value was 71%. We conclude that these scores could be used as a single measure to predict patient disability, although the predictive value was rather weak. Level of evidence: II

Purpose: To map pain frequency and pain intensity according to activities in the physical domain of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), at three, six and nine months after breast cancer surgery. In addition, to verify the correlation between upper limb function and pain intensity. Methods: This is a prospective cohort study, with follow-up at three time points. 22 Brazilian women diagnosed with breast cancer were included at three months after breast surgery. They performed the DASH questionnaire, the Body Pain Diagram and the Visual Analogue Scale. Frequency measures were used to analyze the frequency and intensity of pain in the items of the physical domain of the DASH. Pearson's correlation coefficient between pain intensity and the DASH total score at the three different times was calculated, a 95% confidence interval was set. Results: For twenty-two women at three, six and nine months after surgery, the body area with the highest pain frequency was the upper limb (UL) homolateral to the surgery, although, the contralateral UL was also cited as one of the areas with the highest pain frequency at sixth and ninth month. Pain intensity at three and six months remained mild and moderate in ninth month. The DASH activities with the highest pain frequency were: “putting something on a shelf above your head”, “doing heavy household chores” and “carrying a heavy object”. The correlation between pain intensity and function of the UL contralateral to surgery at nine months was strong (r=0,718; p

Purpose Patients undergoing surgery for trapeziometacarpal (TMC) joint arthritis require preoperative counseling on the expectations of surgery. This study aims to document the objective and functional recovery over the initial 12 months following trapeziectomy and ligament reconstruction with tendon interposition (LRTI). Methods We prospectively followed 55 patients with symptomatic TMC joint osteoarthritis after trapeziectomy and LRTI. Patients were assessed on functional outcome measures, pain, and objective outcomes of grip, tip and key pinch strength, and range of motion. Outcomes were recorded preoperatively and at 3, 6, 9, and 12 months after surgery. Results Outcome measures of Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and pain, improved significantly after surgery at each 3-month interval up to 9 months. Palmar and radial abduction were significantly improved compared to their preoperative ranges, but opposition was unchanged. Power grip significantly exceeded the preoperative strength at 6 months and further increased at 9 months. Tip pinch significantly exceeded the preoperative strength at 12 months. There was no difference in the key pinch strength compared to the preoperative strength. Conclusions Over a follow-up period of 12 months, trapeziectomy and LRTI is an effective treatment in significantly reducing pain in 80% of patients. Although normal patient-reported outcome measures of DASH and PRWE are not regained, when compared to normative values, these measures are significantly improved; the improvement plateaus at 9 months. Patients can expect to attain 37% and 46% of their eventual measured DASH and PRWE scores, respectively, at 3 months, and 82% and 79% of their eventual measured DASH and PRWE scores, respectively, at 6 months. Grip strength exceeded the preoperative strength by 15% at 6 months and by 30% at 9 months. Tip pinch strength significantly exceeded the preoperative strength by 20% at 9 months. Type of study/level of evidence Therapeutic II.

BACKGROUND AND AIMS: Various food groups have been associated with measures of left ventricular geometry and function. Whether the Dietary Approaches to Stop Hypertension (DASH) dietary pattern in mid-life is associated with a favorable cardiac structure and function later in life is unknown. METHODS AND RESULTS: The study population consisted of the Atherosclerosis Risk in Communities study participants free of cardiovascular disease at study visit 3 in 1993 to 1995. Dietary intake was assessed by food frequency questionnaire at study visits 1 (1987–1989) and 3 (1993–1995). Participants who underwent transthoracic echocardiograms at the Jackson field center at visit 3 (n=1,974) and at all field centers at study visit 5 (2011–2013; n=4,651) were included in this study. General linear regression was used to evaluate associations between dietary intake and markers of cardiac structure and function adjusting for potential confounders. Higher DASH score was associated with lower left ventricle mean wall thickness and higher absolute value of longitudinal strain at visit 5 (p(trend)=0.004 and

Hyperlipidemia is linked to poor tendon-to-bone healing and progression of fatty infiltration after rotator cuff repair. Statins effectively treat hyperlipidemia, but it is unknown if they have any potential detrimental effects following rotator cuff repair. The aim of this study was to evaluate the effect of statins on rotator cuff healing and fatty infiltration following repair.A total of 77 patients undergoing arthroscopic rotator cuff repair were recruited prospectively, 38 patients who were prescribed a statin for hyperlipidemia (statin group) and 39 patients who were not taking a statin (control group). Patients who did not have both preoperative and 1-year postoperative magnetic resonance imaging (MRI) scans were excluded from the study. Patient-reported outcome measures, namely the Western Ontario Rotator Cuff (WORC) index, Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, and Disabilities of the Arm, Shoulder and Hand (DASH) score, were collected preoperatively and at 1 year. Fatty infiltration was assessed on MRI according to the Goutallier grade preoperatively and at 12 months; rotator cuff healing was assessed at 12 months according to the Sugaya classification. Following propensity score weighting to adjust for baseline imbalances, 12-month outcomes were compared between the 2 groups.At 12 months, all patient-reported outcome measures had improved significantly compared with baseline (WORC score, 85.9 vs. 32.5, P.001; ASES score, 87.3 vs. 37.5, P.001; Constant-Murley score, 77 vs. 31, P.001; and DASH score, 13.6 vs. 61.4, P.001). There was no significant difference in postoperative scores in the statin group vs. the control group (WORC score, 84.9 vs. 89.6, P = .94; ASES score, 87.5 vs. 86.6, P = .40; Constant-Murley score, 77 vs. 81, P = .90; and DASH score, 14.4 vs. 11.4, P = .14), and for 3 of these scores, the 95% confidence intervals excluded a clinically meaningful difference. Similarly, rotator cuff healing at 12 months and Goutallier fatty infiltration grades were comparable between the 2 groups. Retears were seen in 6 patients (15.8%) in the statin group and 8 (20.5%) in the control group. Progression of fatty infiltration was seen in 4 patients (10.5%) in the statin and 4 (10.3%) in the control group. Statin use did not demonstrate a significant association with either retear risk (P = .41) or progression of fatty atrophy (P = .69).Patient-reported outcomes, rotator cuff retear rate, and fatty infiltration on MRI at 12 months after rotator cuff repair in patients with hyperlipidemia treated with statins are similar to those in a control group.

This study aimed to compare the effects of virtual reality (VR) training and resistance exercises training on lymphedema symptom severity as well as physical functioning and QoL in women with breast cancer–related lymphedema (BCRL). In a single blinded randomized trial, women diagnosed with unilateral BCRL were randomly divided into two groups: the Xbox Kinect group received VR Kinect-based games (n = 30) and resistance exercise group received resistance training (n = 30). In addition, both groups received complex decongestive physiotherapy (manual lymphatic drainage, compression bandages, skin care, and exercises). The intervention was conducted five sessions per week for 8 weeks. The outcome measures included excessive limb volume, visual analogue scale (VAS), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, shoulder range of motion (ROM), shoulder muscles strength, hand grip strength, and Study Short-Form (SF-36). The outcomes were evaluated pre and post intervention (week 8). Statistical significant differences were recorded in VAS (pain intensity), DASH, shoulder ROM (p

The aim of this study was to assess the clinical results after extensor indicis proprius opponensplasty in patients with carpal tunnel syndrome and severe thenar muscle atrophy. Forty patients who underwent this procedure during open carpal tunnel releases. The mean follow-up period was 17 months (range 10 to 36). Kapandji scores significantly improved from 5.5 before surgery to 9.6 at final follow-up. Thumb pronation angle also significantly improved from 111° before surgery to 149°. Side and pulp pinch strength significantly improved postoperatively, as well as DASH scores at final follow-up. In conclusion, the extensor indicis proprius tendon transfer technique represents a reliable opponensplasty procedure to achieve consistent results in patients with severe carpal tunnel syndrome. Level of evidence: IV

Objetivos: Comparar el tratamiento de pacientes con fracturas oblicuas o espiroideas largas de metacarpianos, mediante reducción abierta y fijación interna con tornillos interfragmentarios solos o placas y tornillos. Materiales y Métodos: Se realizó un estudio retrospectivo comparativo entre 2 grupos de pacientes: uno con 24 pacientes tratados con tornillos interfragmentarios solos y otro con 17 pacientes tratados mediante osteosíntesis con placas y tornillos. En ambos, se utilizó un abordaje longitudinal dorsal, y se les indicó inmovilización posoperatoria con valva de yeso y rehabilitación con el mismo equipo de terapistas ocupacionales. Tras un seguimiento mínimo de 12 meses, se evaluaron los resultados con el puntaje DASH, la movilidad activa total, la distancia pulpejo-palma y la fuerza con dinamometría comparativa. Se consideró significativo un valor p

This study aimed to analyse the clinical and radiological outcomes after ulnar head replacement and to compare partial and total ulnar head implants. Twenty-two patients with 23 implants were available with a mean follow-up time of 7 years (range 1.3 to 17) after distal radioulnar joint arthroplasty. At the final follow-up, patients had a low level of pain at rest and during effort, a median Disabilities of the Arm, Shoulder, and Hand (DASH) score of 12 and Patient-Rated Wrist Evaluation score of 12 with partial ulnar head implants, and scores of 20 and 22 in total ulnar head implants, respectively. While the range of motion in patients with partial ulnar head implants was slightly reduced in comparison with the preoperative condition and to the patients with total ulnar head implants, there was a tendency to a higher grip strength and rotational torque. Both types of prosthesis showed sigmoid notch resorptions and resorptions around the neck. We conclude that the results after partial ulnar head replacement do not significantly differ from the total ulnar head implants in many aspects. Level of evidence: III

Background: Mechanical neck pain (MNP) is the most common type of pain confined in the posterior aspect of neck, also known as nonspecific or simple neck pain affecting two thirds of the general population at some time in their lives. Prevalence: Neck pain is most common muscular skeletal condition affecting up to 70% of individual and 5% to 10% of adults having a disabling neck pain problem. Neck pain is more common in women than men. The prevalence of neck pain in the general population has been reported to be 15% for men and 23% for women. Objectives of the Study: To find out the effect of Post Isometric Relaxation (PIR) along with Deep Neck Flexor (DNF) exercises in reducing pain and disability and improving ROM in patient with sub-acute mechanical neck pain. To find out the effect of Deep Neck Flexor exercise alone in reducing pain and disability and improving ROM in patient with sub-acute mechanical neck pain. To compare whether Post Isometric Relaxation (PIR) along with Deep Neck Flexor exercises or Deep Neck Flexor exercises alone are effective in reducing pain and disability and improving ROM in patient with sub-acute mechanical neck pain Methods: Study included 30 patients with lateral epicondylitis between ages 30-50 years. The subjects were randomly divided into 2 groups: Group-A and Group-B. Group A (n = 15) was treated using Cyriax physiotherapy, group B (n = 15) was treated with movement with mobilization. Patients were treated for 3 times a week for 4 weeks. Outcome measures are NPRS (Numeric Pain Rating Scale) and DASH (The Disabilities of the Arm, Shoulder and Hand). Results: The results of the study indicate that there were highly statistically significant improvement in functional disability on NDI, cervical lateral flexion(Right & Left), rotation (Right & Left) ROM and reduction in pain on VAS in Group-A as compared to Group-B. There was no significant difference observed when the groups were compared for cervical flexion and extension ROM. Conclusion: From the result it is concluded that Post isometric relaxation with DNF exercise is effective in mechanical neck pain. Key words: Mechanical neck pain (MNP), Post Isometric Relaxation (PIR), Deep Neck Flexor (DNF) exercise.

Intercondylar fracture of the distal humerus is a relatively rare and challenging intra-articular elbow fracture, with available choice of surgical treatment includes open reduction and extensive internal fixation. This systematic review aims to evaluate the effectiveness of the surgical approach regarding the functional outcome following intercondylar fracture treatment. A systematic search on literature was performed online from the inception dates to November 2020. Main outcome of interest included functional outcomes, Mayo Elbow Performance Score (MEPS) and The Disabilities of the Arm, Shoulder and Hand (DASH) Score. Animal studies, case reports, review articles and non-English papers were excluded. Four articles were included in this review. The functional outcome was different among the olecranon osteotomy approach, triceps on with the triceps sparing approach and triceps off with the triceps lifting approach or the TRAP approach. Triceps on approach with triceps sparing had lower MEPS in patients above 60 years of age but satisfactory in younger patients, while olecranon osteotomy approach showed excellent MEPS rate in all age groups. Olecranon osteotomy approach gives better exposure for more accurate anatomical reduction of the intra articular fracture resulting in better functional outcome. Mean DASH score was significantly higher in Triceps Reflecting anconeus (TRAP) group. Olecranon osteotomy approach was found to be better than triceps on approach, with better functional outcome. However, other triceps off (TRAP) did not show any significant differences in terms of functional outcome in the management of intercondylar fractures. Keywords: intercondylar fractures, olecranon osteotomy, triceps on, triceps off, functional outcome.

Different from developed countries, there is a paucity of research examining how the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets relate to lipids in less-developed ethnic minority regions (LEMR). A total of 83 081 participants from seven ethnic groups were retrieved from the baseline data of the China Multi-Ethnic Cohort study, which was conducted in less-developed Southwest China between May 2018 and September 2019. Multivariable linear regression models were then used to examine the associations of the DASH and alternative Mediterranean diet (AMED) scores, assessed by modified DASH score and AMED, as well as their components with total cholesterol (TC), LDL-cholesterol, HDL-cholesterol, TAG and TC/HDL-cholesterol. The DASH scores were negatively associated with TC, HDL-cholesterol and TAG. Comparing the highest quintiles with the lowest DASH scores, TC decreased 0·0708 (95 % CI −0·0923, −0·0493) mmol/l, HDL-cholesterol decreased 0·0380 (95 % CI −0·0462, −0·0299) mmol/l and TAG decreased 0·0668 (95 % CI −0·0994, −0·0341) mmol/l. The AMED scores were negatively associated with TC, LDL-cholesterol and HDL-cholesterol. Comparing the highest quintiles with the lowest AMED scores, TC decreased 0·0816 (95 % CI −0·1035, −0·0597) mmol/l, LDL-cholesterol decreased 0·0297 (95 % CI −0·0477, −0·0118) mmol/l and HDL-cholesterol decreased 0·0275 (95 % CI −0·0358, −0·0192) mmol/l. Although both the DASH diet and the Mediterranean diet were negatively associated with blood lipids, those associations showed different patterns in LEMR, particularly for TAG and HDL-cholesterol.

Objective: Dietary recommendations (DR) in the USA may be inadequate at improving diets in racial/ethnic minority communities and may require redesign of the systems driving their development over the long term. Meanwhile, cultural adaptation of evidence-based DR may be an important strategy for mitigating nutrition disparities, but less is known about the adaptability of these recommendations to meet the needs of diverse groups. We examined the content and origin of major DRs – aspects that provide context on their potential universality across populations and evaluated their potential for cultural adaptation. Design: Case studies of Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet (MD), the EAT-Lancet diet (EAT) and the NOVA classification system. Setting: United States. Participants: Racial/ethnic minority populations. Results: Current DR differ in their origin/evolution but are similar in their reductionist emphasis on physical health. DASH has been successfully adapted for some cultures but may be challenged by the need for intensive resources; MD may be more beneficial if applied as part of a broader set of food procurement/preparation practices than as just diet alone; EAT-Lancet adaptation may not honor existing country-specific practices that are already beneficial to human and environmental health (e.g. traditional/plant-based diets); evidence for cultural adaptation is limited with NOVA, but classification of levels of food processing has potential for widespread application. Conclusions: For DR to equitably support diverse populations, they must move beyond a Eurocentric or ‘general population’ framing, be more inclusive of cultural differences and honour social practices to improve diet and reduce disparities.

BACKGROUND: The blood pressure–lowering effects of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and reduced sodium intake are well established. The effects on other biomarkers related to vascular health are of interest and might assist in explaining the effects of the DASH diet and sodium reduction. OBJECTIVES: We hypothesized that a low-sodium DASH diet improves (lowers) biomarkers of inflammation [C-reactive protein (CRP) and soluble urokinase plasminogen activator receptor (suPAR)] and mineral metabolism [phosphorus and fibroblast growth factor-23 (FGF23)]. METHODS: We conducted a secondary analysis of the DASH-Sodium trial using frozen serum samples. This controlled feeding study randomly assigned 412 adults (≥22 y) with elevated blood pressure (120–159/80–95 mmHg) to consume either a DASH diet or control diet. Within each arm, participants received 3 sodium levels [low (1150 mg), intermediate (2300 mg), high (3450 mg)] in random sequence, each for 30 d. To maximize contrast, samples collected at the end of the low-sodium DASH (n = 198) and high-sodium control (n = 194) diets were compared. Between-diet differences in serum CRP, suPAR, phosphorus, and FGF23 concentrations were assessed using linear regression adjusted for age, sex, race, income, education, smoking status, and BMI. RESULTS: CRP concentrations did not differ between groups (P = 0.83), but suPAR was higher after the low-sodium DASH diet than the high-sodium control [geometric mean 2470 pg/mL (95% CI: 2380, 2560 pg/mL), compared with 2290 pg/mL (95% CI: 2210, 2380 pg/mL); P = 0.006]. Phosphorus was higher after the low-sodium DASH diet [geometric mean 3.50 mg/dL (95% CI: 3.43, 3.57 mg/dL)] compared with the high-sodium control diet [geometric mean 3.39 mg/dL (95% CI: 3.33, 3.46 mg/dL); P = 0.04]. FGF23 was also higher after the low-sodium DASH diet [geometric mean 35.3 pg/mL (95% CI: 33.3, 37.3 pg/mL) compared with 28.2 pg/mL (95% CI: 26.6, 29.8 pg/mL); P

Introduction: One of the most common fractures is a forearm fracture. The most common causes of these fractures include high-energy incidents, direct trauma, and falls from great heights. It's not unusual to have open wounds with a neurovascular impairment. Supination of the forearm with a backward and upward loading force with a forward angulation while falling on an outstretched hand is comparatively a less severe mechanism than pronation and upward force. Direct impact which is referred to as ‘Nightstick injury’ also lead to shaft of ulna fracture. The goal of this study was to assess the results of closed fixation in radius ulna fractures with intramedullary nailing for a minimum of 6 months. Nailing with square nails, titanium elastic nails (TENS nails), or long Kirschner wire has proven to be extremely effective. Method: Over the course of one year, this is a retrospective case series investigation of forearm bone fractures and the treatment options available. We chose patients where intramedullary nailing was used as a therapy option and were followed for at least 6 months. Galeazzi variety, monteggia variety, pathological fracture, and non-union following previous surgery were all ruled out. Disabilities of the arm, shoulder, and hand (DASH) score and Grace and Eversmann functional outcome score were used to assess the results. Results: Of the 25 patients, 14 patients had excellent functional outcome according to Grace and Eversmann score, 8 patients had good outcome, 4 patients had acceptable while 1 was unacceptable. The mean DASH score was 16.32. Conclusion: This study shows that closed method for fixation by intramedullary nailing of both bone forearm fractures leads to excellent to good functional outcomes (according to DASH score and Grace and Eversmann score) with less complications. In 6 months follow up x ray there is radiological union in all cases with no angulation, malunion or non-union.

Background In individuals with chronic kidney disease (CKD), healthy dietary patterns are inversely associated with CKD progression. Metabolomics, an approach that measures many small molecules in biofluids, can identify biomarkers of healthy dietary patterns. Objectives We aimed to identify known metabolites associated with greater adherence to 4 healthy dietary patterns in CKD patients. Methods We examined associations between 486 known plasma metabolites and Healthy Eating Index (HEI)-2015, Alternative Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet, and alternate Mediterranean diet (aMED) in 1056 participants (aged 21-74 y at baseline) in the Chronic Renal Insufficiency Cohort (CRIC) Study. Usual dietary intake was assessed using a semiquantitative FFQ. We conducted multivariable linear regression models to study associations between healthy dietary patterns and individual plasma metabolites, adjusting for sociodemographic characteristics, health behaviors, and clinical factors. We used principal component analysis to identify groups of metabolites associated with individual food components within healthy dietary patterns. Results After Bonferroni correction, we identified 266 statistically significant diet-metabolite associations (HEI: n = 60; AHEI: n = 78; DASH: n = 77; aMED: n = 51); 78 metabolites were associated with >1 dietary pattern. Lipids with a longer acyl chain length and double bonds (unsaturated) were positively associated with all 4 dietary patterns. A metabolite pattern low in saturated diacylglycerols and triacylglycerols, and a pattern high in unsaturated triacylglycerols was positively associated with intake of healthy food components. Plasmalogens were negatively associated with the consumption of nuts and legumes and healthy fat, and positively associated with the intake of red and processed meat. Conclusions We identified many metabolites associated with healthy dietary patterns, indicative of food consumption. If replicated, these metabolites may be considered biomarkers of healthy dietary patterns in patients with CKD.

Aim and Objective: This study has been taken to determine the functional outcome of treating diaphyseal fractures of both bones, forearm with Dynamic compression plate at Mediciti institute of medical sciences, Ghanpur from October 2018 to March 2020. Methodology: This is a time-bound prospective study. Twenty cases of fractures of both bones forearm was treated by open reduction and internal fixation with 3.5 mm DCP. The follow-up ranged from 5 months to 18 months. Results: Males predominant with right forearm affection more than left. Most of the fractures due to RTA and fall. The average age was 35 years with fracture being most common in third decade. Most of the fractures of both bones forearm were located in the middle third and the fracture pattern transverse/short oblique was commonest. 18 (90%) patients has sound union in less than 6 months, 2 (10%) patients had delayed union. The results were based on Dash scoring system and in our study, there were 18 (90%) patients with excellent results and 2 (10%) with satisfactory and no unsatisfactory results. Conclusion: Hence the study was on par with the previous studies and DCP is proved to be the best mode of treatment for diaphyseal fractures of both bones forearm.

Approximately 30% of all upper extremity fractures are elbow fractures which may result elbow stiffness. This study aimed to investigate the efficacy of onaBotulinum Toxin type A injection to prevent post-traumatic pain and elbow-stiffness. All patients were included who presented to a single surgeon with supracondylar/ intraarticular distal humerus fractures, proximal ulna and radius fractures. The study was developed in a randomized placebo controlled study between 2003-2007. The Disabilities of the Arm, Shoulder, and Hand (DASH) score as well as the arc-of-motion (AOM) were assessed after three, six, twelve-months and final follow up for evaluation. Of the 31-patients included, 15-patients (48.4%) received Botox injections. In all patients no complication was observed when injecting a dosage 100-units for the brachialis and biceps brachii muscles. Furthermore, it was an effective method to prevent post-traumatic elbow stiffness, lasting six- months. Significant differences in DASH, VAS-score and ROM after three-months between the Botox and control group (DASH 21.6±11.0 vs. 55.3±11.0 ; VAS 1.2±5.2 vs. 5.7±21.9 ; ROM 103±7.6 vs. 73±6.3 ; p>0.05) were identified in the prospective group. Botulinum toxin is a safe, reliable and effective treatment to prevent post-traumatic elbow stiffness. Our study demonstrates improved early range-of- motion (p

It is, indeed, a privilege to stand here before you this morning to give the annual Flege Lecture. Dr. Sande Starnes has kindly supplied me with a list of prior visiting professors, who previously have had the honor to deliver this talk. When we examine the names of those who have been so honored, and note their many accomplishments, I cannot help but remember the words of Winston Churchill, who, when speaking of another person, could well have been speaking of me, when he described “a modest little person, with much to be modest about.”

BACKGROUND: The identification of factors that are related to return to work after surgery for breast cancer could help healthcare professionals accurately identify patients at risk of return to work-related difficulties in order to provide them with appropriate support during breast cancer management. OBJECTIVE: The aim of this study was to identify factors related to return to work in breast cancer patients three months after axillary lymph node dissection. METHODS: Seventy-three women who were working before the surgery were evaluated. Age, body mass index, level of lymph node dissection, marital status, children, co-resident household members, preoperative chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, shoulder range of motion, upper limb function (Disabilities of the Arm, Shoulder and Hand; DASH), and work were evaluated. Patients who had returned to work constituted the return to work group, and those who had not returned to work constituted the no return to work group. RESULTS: Of the patients, 36 returned to work at three months. Logistic regression analysis including the five variables showed that shoulder flexion range of motion and DASH were significantly associated with return to work (p

We aim to explore the clinical efficacy of a new surgical approach called improved abdominal hypodermal pocket for salvage of the amputated fingertip distal to the lunula (Tamai Zone I). From September 2015 to June 2017, we treated 18 fingertips of 15 patients with abdominal hypodermal pocket after all fingertips were completely amputated and finger replantation could not be attempted. After 3 weeks, all fingertips were removed from the abdomen. After 1 year, outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score, static two-point finger discrimination and Chinese Medical Association upper limb function evaluation trial standard. All 18 fingertips survived. Two fingertips developed partial necrosis, and the scar healed with dressing changes. All patients were satisfied with the appearance of the fingertips except one woman who was not satisfied due to ischaemic atrophy. The DASH score ranged from 35–46 (average 38), and static two-point discrimination was 6–14 mm (average 8 mm). When vascular anastomosis is not feasible in fingertip replantation, improved abdominal hypodermal pocket is an alternative that can meet the needs of good appearance, such as length, plump finger pulp and nail integrity, with a high survival rate, low technical difficulty and minimal complications.

The prevalence of non-communicable hypertension in Indonesia in 2007, 2013, and 2018 tends to increase. This phenomenon is predicted to continue. Riskesdas shows that the prevalence of hypertension in 2018 shows the number in the population aged over 18 years based on national measurements of 34.11%. Based on the annual report of the Cinunuk Public Health Center, it shows that hypertension is the largest non-communicable disease pattern in the Cinunuk Public Health Center in 2020, reaching 2672 cases of disease from 12517 cases of other diseases with a percentage of 21.34%. Hypertension is still a major public health problem associated with considerable morbidity and mortality. Hypertension can be controlled consistently by modifying a healthy lifestyle. The DASH (Dietary Approach To Stop Hypertension) dietary intervention recommended in national guidelines can substantially lower blood pressure in both people with hypertension and those without hypertension. This study aims to determine the relationship between knowledge of DASH (Dietary Approach To Stop Hypertension) and hypertension in Cinunuk village in 2021. This study was conducted using a quantitative method with a cross-sectional approach using primary data obtained through google form distribution. The research subjects were the people of Cinunuk Village, Cimekar, a total of 103 respondents who met inclusion and exclusion criteria. The results of this study indicate that there is a relationship between Knowledge of DASH and Hypertension in Cinunuk Village (P 0.049), where the hypertension proportion was significantly smaller (2.6%) than the no-hypertension percentage (15.6%) in the group who familiar with DASH. Lifestyle modification, including DASH, play an important role in controlling hypertension.

Lifestyle improvement is a cornerstone of cardiovascular disease prevention and has a relevant effect on blood pressure control. During the last decades the attention of the researcher has focused on low-salt diets as the lifestyle modification most effective in blood pressure reduction. Current international guidelines thus suggest to stress the importance of the implementation of the dietary approach to stop hypertension (DASH) diet and of a low-salt Mediterranean diet to achieve the best results in term of blood pressure decrease. However, salt reduction in diet could be not the only nor the main determinant of blood pressure reduction under dietary treatment. DASH and low-salt Mediterranean diet are also characterized by a high intake of vegetables (NO and polyphenol sources), whole grains, some low-fat dairy products, and low intake of red meat, sugar, and trans-hydrogenated fats. Lacto-ovo vegetarian diet are also per se associated to a significant improvement in blood pressure levels. Moreover, these diets are particularly effective when associated with a significant weight loss. Furthermore, blood pressure can also be lowered by some nutraceuticals (beetroot, magnesium, vitamin C, catechin-rich beverages, lycopene, etc). The aim of this narrative review is to critically resume the most recent evidence supporting a complete approach to dietary counseling for hypertension prevention and management.

Background : Joint replacement surgery as a treatment for complex proximal humeral fractures is an established option, especially in the elderly. In light of the increased attention to reverse total shoulder arthroplasty (rTSA), this study has analyzed the outcomes of patients with primary reverse arthroplasty and after secondary reverse arthroplasty for failed osteosynthesis. Methods : We retrospectively reviewed 57 patients with an average age of 76 years (min. 55; max. 94; SD 7) from 2010 and 2015 who underwent primary rTSA (30) and secondary rTSA after the failure of plate osteosynthesis (27) after proximal humeral fractures. The functional outcome of the operated shoulder was evaluated by clinical scores (Constant-Score, ASES, DASH and Oxford), range of motion (RoM), pain and activity level. Results : Primary rTSA had a significantly better functional outcome, mean-follow-up 37.3 months, measured by Constant-Score (57.13 vs 45.78 points; p= .015) compared to secondary RTSA, mean follow-up 42.1 months. A significantly better active abduction (p = .002), forward flexion (p = .003) and internal rotation (p = .037) was observed in the primary rTSA group, especially in the follow-up > 35 months. Conclusion : Reverse shoulder arthroplasty is an effective treatment for proximal humeral fractures as primary or revision surgery. The reliable clinical outcome especially in the follow-up to 40 months after primary reverse arthroplasty may suggest to prefer rTSA for complex humeral fractures in the elderly.

Background: Multiple Sclerosis (MS) is an unpredictable autoimmune disease that causes damage to the central nervous system including brain, spinal cord and optic nerve. This damage occurs as the body’s immune system attack the protective coating called myelin around nerve fibers in the central nervous system. It can affect different aspects of a person’s physical and cognitive functioning. Multiple Sclerosis is a complex, chronic disease that necessitates the support of a knowledgeable and concerned team of healthcare providers. This study aimed to assess the relation between upper extremity motor function among patients with MS with fatigue and cognitive impairment. Descriptive correlational research design was conducted on sixty adult patients with the diagnosis of MS who were admitted the MS Outpatient Clinic of El-Hadara Hospital in Alexandria. Four tools were used for collecting data: Tool I: Demographic and clinical data tool, tool II: Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, tool III: Multiple sclerosis Neuropsychological screening questionnaire, and Tool IV: Fatigue assessment tool. Results of the present study revealed that moderate disability of the upper extremity was the most disability level encountered representing more than one third among the study sample (36.7%) , furthermore; more than two third (73.3%) the study sample often having cognitive problems, suffering from severe fatigue (36.7%) and fatigue partially interfered with their quality of life(46.7%). Additionally, there was no significant relation between studied patients' motor function of upper extremity and their cognitive function p=0.54. On the other hand, there was a significant relation between studied patients' motor function of upper extremity and fatigue severity level, and effect of fatigue on their quality of life. Accordingly, conducting a comprehensive assessment of patients' upper extremity motor function, cognitive function, and fatigue level among patients with MS is necessary to determine the degree of suffering; this will help the nurses to predict their functional status and the effect of MS on their quality of life.

BACKGROUND Although higher diet quality at mid-life has been associated with better cognitive function in late adulthood, it is unclear whether dietary improvement after mid-life may reduce the risk of cognitive impairment. OBJECTIVES We examined associations between changes in diet quality and risk of cognitive impairment in the Singapore Chinese Health Study cohort. METHODS We used data from 14,683 Chinese men and women who were recruited at ages 45 to 74 y from 1993 to 1998 and re-interviewed after 20 y at ages 61 to 96 y during follow-up 3 (2014-2016). Diet quality was measured using the Dietary Approaches to Stop Hypertension (DASH) scores at baseline and follow-up 3 interviews. Cognitive impairment was defined using scores from the Singapore-modified Mini-Mental State Examination at the follow-up 3 interview. Multivariable logistic regression models were used to estimate ORs and 95% CIs for the associations between change in DASH scores and cognitive impairment. RESULTS Higher quintiles in DASH scores at baseline and follow-up 3 interviews were associated with lower odds of cognitive impairment in a dose-dependent manner (both: P-trend

Introduction Bone grafts have been used for augmentation and to improve stability of reduced fractures in proximal humeral fractures. The aim of this study was to analyze the clinical and radiological outcomes following use of cancellous bone (CA) allografts for augmentation in three- or four-part proximal humeral fractures, and compare with fibular strut allografts (FA). Patients and Methods Between November 2016 and February 2018, 55 patients, followed for at least 1 year, with three- or four-part proximal humeral fractures fixed with locking plates were included and grouped according to the type of allograft bone used for augmentation. In this retrospective analysis, we assessed and compared the clinical and radiological outcomes of the two groups, using the visual analogue scale (VAS) score, the Constant–Murley score (CMS), the disability of the arm, shoulder and hand (DASH) score, the range of movement (ROM), neck-shaft angle (NSA), humeral head height (HHH) and the changes of NSA and HHH, as well as recording any complications. The repeatedly-measured clinical and radiological outcomes were analyzed by linear mixed models. The differences in outcomes between groups at the final follow-up were compared by Student’s t test. Results There were 28 patients in the CA group and 27 patients in the FA group with an average follow-up of 14.5 months. The mean age of all patients was 64 (36 to 86). Non-significant group effects were observed on CMS (β = -8.792, P = 0.216), DASH (β = 1.329, P = 0.094), NSA (β = 1.432, P = 0.752) and HHH (β = 1.660, P = 0.628). At the final follow-up, the patients in the CA group showed no significant differences in VAS (1.8 vs 2.2, P = 0.276), CMS (81.5 vs 75.4, P = 0.072), and DASH (11.0 vs 13.5, P = 0.235) scores compared to the FA group. There were no significant differences in the change of NSA (6 vs 4, P = 0.387) or HHH (1 vs 2, P = 0.261). Conclusions Patients with three- or four-part proximal humeral fractures treated with locking plates combined with cancellous bone allografts have good clinical and radiographic outcomes, moreover similar to those treated with fibular strut allografts. Level of evidence Level III; Retrospective Cohort Comparison; Treatment Study

Since the introduction of stemless anatomic shoulder arthroplasty, few midterm functional and radiographic results have been published. This article presents results of the Arthrex Eclipse prosthesis with a mean follow-up of 70 months.We prospectively evaluated the outcome of 53 arthroplasties in 51 patients with a mean age of 65 years at the time of implantation with a minimum follow-up of 48 months. All patients were physically and radiologically examined, and the results documented by Constant-Murley and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.Significant improvements from preoperative to last follow-up were documented in the Constant-Murley score (53.8%-83.5%, P.001) and active range of motion (abduction 84°-108°, flexion 98°-125°, and external rotation 19°-41°). There was no significant difference between total and hemiarthroplasty. The mean DASH score was 28.3 points (95% confidence interval 20.1-35.2). Lowering of bone mineral density was observed in anteroposterior radiographs at the humeral component in 24.5% and at the glenoid component in 33.3%. The rate of complications was 15.7%.This study finds improvements in functional, radiographic, and subjective midterm results comparable to other accessible data for stemless and stemmed arthroplasty.