A 2-Stage 6 Toe-to-Hand Transfer for the Reconstruction of Bilateral Digitless Hands.

Reconstruction of metacarpal hands remains a challenging problem for hand surgeons. In this case report, we present a middle-aged female patient with bilateral Wei Type IIB metacarpal hands secondary to severe burn injuries following a motor vehicle accident. The patient underwent a 2-stage reconstruction with big, second, and third toes transfer in each hand to restore tripod pinch.

Neuroma Treatment With the Acellular Nerve Allograft Reconstruction Technique.

Treatment of a painful neuroma is a challenging problem for both the patient and the providers. Current surgical treatment options typically include excision of the neuroma and stump relation. However, with both treatment options, patients have high rates of persistent pain and rates of neuroma recurrence.

Microbiota members from body sites of dairy cows are largely shared within individual hosts throughout lactation but sharing is limited in the herd.

Background: Host-associated microbes are major determinants of the host phenotypes. In the present study, we used dairy cows with different scores of susceptibility to mastitis with the aim to explore the relationships between microbiota composition and different factors in various body sites throughout lactation as well as the intra- and inter-animal microbial sharing.

Results: Microbiotas from the mouth, nose, vagina and milk of 45 lactating dairy cows were characterized by metataxonomics at four time points during the first lactation, from 1-week pre-partum to 7 months post-partum.

Free Vascularized Fibula Graft for Staged Reconstruction of Infected Humerus Nonunions.

Objective: To evaluate the union rate and rate of postoperative complications in patients with septic nonunions of the humerus after a two-stage reconstruction using a free vascularized fibula graft.

Design: Retrospective case series.

Setting: Academic, tertiary referral center.

Standardized Whole Blood Assay and Bead-Based Cytokine Profiling Reveal Commonalities and Diversity of the Response to Bacteria and TLR Ligands in Cattle.

Recent developments in multiplex technologies enable the determination of a large nu\mber of soluble proteins such as cytokines in various biological samples. More than a one-by-one determination of the concentration of immune mediators, they permit the establishment of secretion profiles for a more accurate description of conditions related to infectious diseases or vaccination. Cytokine profiling has recently been made available for bovine species with the development of a Luminex technology-based 15-plex assay.

Necrotizing Soft Tissue Infection of the Upper Extremity as a Manifestation of Hansen's Disease.

Hansen's disease is a well-described, largely historic infection that is caused by . Lucio's phenomenon is an aggressive, rare form of untreated lepromatous leprosy characterized by diffuse cutaneous lesions and systemic symptoms. To date, cases of necrotizing soft tissue infection in the setting of leprosy have rarely been reported in the literature.

Flexor Tenosynovitis Caused by .

is a rare etiology of serious hand infection with only 2 cases having been reported in literature to date to our knowledge. We describe the case of a 58-year-old woman with persistent swelling and stiffness in her right index finger. Advanced imaging studies in addition to serial surgical debridement with tissue cultures helped to confirm the diagnosis of flexor tenosynovitis caused by .

Forearm and Arm Tourniquet Tolerance.

Background: In distal upper extremity surgeries, there can be a choice to use an upper arm or forearm tourniquet. This study examines discomfort and tolerance in healthy volunteers to determine whether one is more comfortable.

Methods: Forty healthy, study participants were randomized to an upper extremity laterality and site.

Google trends as a tool for evaluating public interest in total knee arthroplasty and total hip arthroplasty.

Background And Aims: There are approximately 1 million total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures performed annually in the United States. With this number projected to increase, it is vital for orthopedic surgeons and health-care systems to properly anticipate healthcare utilization related to TKA and THA. Google Trends (GT) is a free, open source tool that provides customizable analysis of search terms entered into the Google search engine.

Differentiating Upper Extremity Necrotizing Soft Tissue Infection From Serious Cellulitis and Abscess.

Introduction Necrotizing soft tissue infection (NSTI) of the upper extremity (UE) is a rapidly progressing infection that requires early diagnosis and emergent treatment to decrease risks of loss of limb or life. Clinical presentation, particularly of early NSTI, can appear similar to serious cellulitis or abscess. The purpose of this study was to identify factors that are associated with NSTI rather than serious cellulitis and abscess to differentiate patients with similar clinical presentations.

Risk Factors Associated With Progression to Surgical Release After Injection of Trigger Digits.

Introduction: The mainstay of trigger finger treatment is a corticosteroid injection of the affected digits and is associated with a very high success rate. However, some patients do not respond to nonsurgical management and undergo subsequent surgical release. The purpose of this study is to investigate the comorbidities that predispose patients to progressing from injection to surgical release.

Treatment of Iatrogenic Saphenous Neuroma after Knee Arthroscopy with Excision and Allograft Reconstruction.

Unlabelled: The treatment of postoperative, painful sensory neuromas is an ongoing challenge for surgeons. Here, we describe a technique for treatment with excision and allograft reconstruction and report on early results of its use in treating painful saphenous neuromas after knee arthroscopy.

Methods: A retrospective review of a single surgeon's peripheral nerve clinic from January 1, 2013, to December 31, 2019, was conducted to identify post-knee arthroscopy saphenous neuroma cases in which reconstruction with processed human nerve allograft distally implanted into healthy muscle belly was performed.

Public Interest in Elective Orthopedic Surgery Following Recommendations During COVID-19: A Google Trends Analysis.

Introduction Precautions issued by organizations such as the American Academy of Orthopaedic Surgeons (AAOS) recommending against any elective, or non-essential, surgical procedures have significantly affected healthcare resource utilization by the public during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In this study, we demonstrate the value of the Google Trends (GT) interface to characterize and monitor in real-time the response in public interest toward various elective orthopedic procedures. Methods Search volume databases were generated from January 2015 to May 2020 for keywords related to anterior cruciate ligament (ACL) reconstruction, elbow arthroplasty, hip arthroplasty, knee arthroplasty, and rotator cuff repair.

Confirmed effects of candidate variants for milk production, udder health, and udder morphology in dairy cattle.

Background: Over the last years, genome-wide association studies (GWAS) based on imputed whole-genome sequences (WGS) have been used to detect quantitative trait loci (QTL) and highlight candidate genes for important traits. However, in general this approach does not allow to validate the effects of candidate mutations or determine if they are truly causative for the trait(s) in question. To address these questions, we applied a two-step, within-breed GWAS approach on 15 traits (5 linked with milk production, 2 with udder health, and 8 with udder morphology) in Montbéliarde (MON), Normande (NOR), and Holstein (HOL) cattle.

Characteristics of Iatrogenic Nerve Injury from Orthopedic Surgery Correlate with Time to Subspecialty Presentation.

Unlabelled: There is no current literature examining iatrogenic nerve injury resulting from orthopedic procedures across subspecialties and anatomic areas. This study uses a single peripheral nerve surgeon's experience to investigate the variable time to presentation of adult patients with iatrogenic nerve injury after orthopedic surgery.

Methods: A retrospective review of patients examined in Peripheral Nerve Clinic (PNC) from January 1, 2012, to April 1, 2018, at a single, private, university hospital was performed.

Horseshoe abscess of the hand with rice bodies secondary to mycobacterium avium intracellulare infection.

A horseshoe abscess is caused by infection that spreads between the flexor tendon sheath of the thumb or little finger through the radial and ulnar bursae through communication between the two and/or the space of Parona. We present a case of an 80-year-old woman with rheumatoid arthritis who presented with 6 months of right hand and wrist soft tissue swelling, initially treated as a rheumatoid arthritis flare. MRI demonstrates the horseshoe abscess and after surgical irrigation and debridement with synovectomy, cultures demonstrated infection with mycobacterium avium intracellulare (MAI).

Management of Critical Bone Defects.

Bone defects may occur after trauma, infection, or oncologic resection. A critical sized defect is any defect that is unable to spontaneously heal and will require secondary procedure(s) to obtain union. Autologous grafting is widely used, but may be insufficient to obtain union in these situations.

Bridge Plate Failure with Extensor Tendon Injury: A Case Report and Literature Review.

Background: Dorsal spanning plate fixation is an increasingly popular method of fixation for certain distal radius fractures. Published outcomes are encouraging, but complications are still reported.

Methods: We present a case report of a 26-year-old woman with spanning plate breakage and extensor pollicis longus (EPL) metallosis, fraying, and near-complete rupture.

Peripheral nerve injury with Nexplanon removal: case report and review of the literature.

Background: Implantable devices offer convenient, long-acting, and reversible contraception. Injury to the peripheral nerves and blood vessels have been reported as rare complications of implantation and extraction.

Case Presentation: We present a case of ulnar nerve injury in a 21-year-old woman from attempted in-office removal of a deeply implanted Nexplanon® device.

Halofuginone inhibits TH17 cell differentiation by activating the amino acid starvation response.

A central challenge for improving autoimmune therapy is preventing inflammatory pathology without inducing generalized immunosuppression. T helper 17 (TH17) cells, characterized by their production of interleukin-17, have emerged as important and broad mediators of autoimmunity. Here we show that the small molecule halofuginone (HF) selectively inhibits mouse and human TH17 differentiation by activating a cytoprotective signaling pathway, the amino acid starvation response (AAR).

The Same Old Song?-Stability and Change in Relationship Schemas From Adolescence to Young Adulthood.

Relationship schemas are core elements of personality that guide interpersonal functioning. The aim of this study is to examine stability and change in relationship schemas across two developmental epochs-adolescence and young adulthood-in the stories that people tell about their interactions with others. Using the Core Conflictual Relationship Theme Method, relationship themes were coded from semistructured interviews conducted in adolescence and again at age 25.

Developing a baseline assessment battery: balancing patient time burden with essential clinical and research monitoring.

Objective: Baseline assessment in a multisite alcohol-dependence treatment study has several purposes: addressing inclusion/exclusion criteria and characterizing participants to illuminate subsequent efficacy and safety patterns of the interventions. Combination pharmacotherapy and behavioral therapy trials, however, require more complex assessments than single-modality studies. Medication trials require measures of initial safety for study drug as well as for subsequent side-effect and adverse-effect monitoring (e.

"This is a bad dog, you know...": constructing shared meanings during sibling pretend play.

The construction of shared meanings in play, pretense enactment, internal state language, and sibling relationship quality were investigated in 40 kindergarteners with an older (M age = 7.10 years) or younger (M age = 3.6 years) sibling.